Expert Perspectives on a 77-Year-Old Man With Relapsed Chronic Lymphocytic Leukemia - Episode 7
Andrew Zelenetz, MD, reflects on the impact of moving agents to the frontline for treatment of chronic lymphocytic leukemia and how that impacts treatment decisions in relapsed/refractory chronic lymphocytic leukemia.
Andrew Zelenetz, MD: We know that the whole field of CLL [chronic lymphocytic leukemia] is changing. As we start to move more of these agents into the frontline and we use combinations of venetoclax and BTK [Bruton tyrosine kinase] inhibitors, it will raise challenges to us for what we do in the relapse/refractory setting. That’s where we’re going to see the PI3K inhibitors emerge as an important role, even if they have their use as a bridging strategy for patients who are then going to go on to CAR [chimeric antigen receptor] T cells, which can be highly effective in relapse/refractory disease.
One thing that’s important is that CLL evolves over time. It’s very important, when your patient is progressing, that you reevaluate them. Their IGHV mutation status will never change. But their TP53-mutation status can change. Their FISH [fluorescence in situ hybridization] characteristics can also change. If they have complex carrier type, then that will definitely evolve. Knowing how high risk a patient is, is going to help you sort through the options for the patient relapse/refractory CLL.
This transcript has been edited for clarity.
Case: A 77-Year-Old Man With Chronic Lymphocytic Leukemia