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Current Options for Frontline Treatment of CLL

Danielle Brander, MD
Published Online:4:41 PM, Wed October 10, 2018

Danielle Brander, MD, assistant professor at Duke University and the Duke Cancer Institute, discusses the current treatment landscape in the frontline setting for patients with chronic lymphocytic leukemia (CLL). 

There have been changes for this patient population in the frontline, as well as those with relapsed/refractory CLL. For frontline treatment, Brander says the biggest change has been in identifying patients eligible for long-term chemoimmunotherapy that will benefit the most. These are the younger, more favorable-risk patients that are IGHV-mutated with no high-risk deletion 11q or 17p. 

Older patients with favorable-risk disease can also have a meaningful remission from a fixed duration of frontline chemotherapy, or even a bendamustine plus rituximab (Rituxan) combination, Brander says. However, she won’t use that combination for her younger patients.

The only FDA approved targeted agent is ibrutinib (Imbruvica). In a recent publication looking at 5-year follow-up in a cohort of patients treated in the first-line, Brander says we learned that patients who were not high risk had extremely low progression-free survival over the 5 years.
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