Study Reveals Patient-Oncologist Gaps in Post-cBTKi CLL Treatment Preferences

Patients with chronic lymphocytic leukemia (CLL) and the oncologists who treat them hold notably different priorities when selecting therapy after covalent Bruton tyrosine kinase inhibitor (cBTKi) treatment, according to findings from a new US-based preference study published in Leukemia & Lymphoma.¹ The results highlight a meaningful disconnect between the consistency of oncologist preferences and the considerable heterogeneity observed among patients, with implications for treatment planning and shared decision-making in the post-cBTKi setting.

In the study, a total of 300 participants—150 patients with CLL and 150 hematologists/oncologists who treat CLL—completed an online discrete choice experiment and preference survey designed to quantify the tradeoffs each group was willing to make between key attributes of available therapies. Specific attributes evaluated included efficacy (progression-free survival [PFS]), risk of adverse effects, treatment duration (fixed duration vs continuous), and risk of discontinuation due to intolerability. All participants were based in the United States.

Oncologists: Efficacy Predominates, Duration Less Critical

Among oncologists, treatment preferences were strikingly consistent. PFS emerged as the dominant driver, with a relative attribute importance (RAI) of 44.7% (95% CI, 41.6%-47.6%) of oncologist choice behavior. Risk of treatment discontinuation due to intolerability contributed a further 22.9% (95% CI, 20.5%-25.2%). By contrast, the importance of fixed-duration vs continuous therapy—a consideration that looms large in clinical discussions—accounted for only 3.6% (95% CI, 1.6%-5.4%) of choice behavior when weighed alongside other attributes.

This hierarchy held regardless of patient age or the reason the patient had previously discontinued cBTKi therapy, reflecting the evidence-based, outcomes-centered framework that oncologists tend to apply when selecting treatment. Willingness-to-trade-off analyses further reinforced this picture, showing oncologists were unlikely to accept a meaningful reduction in PFS in exchange for improvements in other treatment attributes.

Patients: Heterogeneous, Individualized Priorities

The patient cohort presented a more complex picture; while patients did value treatment efficacy, it was not the sole driver. The RAI for median duration of PFS was 49.9% (95% CI, 43.4%-56.5%). Other patients placed weight on reducing the risk of adverse effects (RAI, 12.2%; 95% CI, 7.5%-17.0%), while others prioritized minimizing the likelihood of treatment discontinuation due to intolerability (RAI, 16.3%; 95% CI, 11.6%-21.1%), treatment duration, or mode and frequency of administration.

Notably, these preference subsets could not be attributed to differences in observed disease characteristics or sociodemographic factors. This finding is clinically significant, as it suggests that there is no readily identifiable patient profile that predicts what an individual will prioritize, and that standard demographic or clinical proxies are insufficient to anticipate patient preferences in this setting.

Implications for Clinical Practice

The divergence between oncologist and patient priorities has important implications for treatment selection and shared decision-making in the second- and later-line settings. In the current post-cBTKi landscape, available options—including the noncovalent BTKi pirtobrutinib (Jaypirca) and the BCL2 inhibitor venetoclax (Venclexta)—carry meaningfully different profiles with respect to PFS, adverse effect risks, mode of administration, and treatment duration. These differences closely mirror the attributes patients weighted variably in this study.

As the number of available therapies in relapsed/refractory CLL continues to expand, these data emphasize the importance of personalized treatment planning and clear communication to ensure therapeutic decisions align with patient goals and expectations. The findings further support the need for a broad range of treatment options capable of addressing the diverse preferences observed among patients in this setting.

“This highlights the need for clear communication between patients and providers to ensure care is consistent with the patient’s personal goals for care,” authors Michaels-Igbokwe et al concluded.¹ “Additional research is needed to better understand the factors associated with differences in patient preferences for CLL treatments.”

REFERENCE

1. Michaels-Igbokwe C, Lu H, Winfree KB, Bhandari NR, Abhyankar S, Fernandez GS, Das A, Hess LM. Treatment choice for chronic lymphocytic leukemia after covalent BTKi therapy: a patient and oncologist preference study. Leuk Lymphoma. Published online April 10, 2026. doi:10.1080/10428194.2026.2648867