Considerations with Retreatment of Venetoclax-Containing Regimens

Venetoclax Retreatment Strategies and Continuous Therapy

This segment examines the appropriateness of venetoclax retreatment in patients who previously achieved deep remissions but developed BTK inhibitor intolerance. With a three-year remission and achievement of MRD negativity, the patient doesn't clearly meet criteria for venetoclax-refractory disease, making retreatment a reasonable consideration.

The discussion weighs the benefits of time-limited venetoclax therapy versus continuous BTK inhibitor approaches for high-risk disease. While venetoclax retreatment may be effective, many experts favor continuous BTK inhibition for patients with newly acquired high-risk genomic features due to the drugs' ability to suppress proliferation of high-risk clones.

Available data from studies like Murano provide some evidence supporting venetoclax retreatment strategies, though the median progression-free survival of 24 months in retreatment scenarios suggests limitations. Real-world experience and ongoing studies like the REVENGE trial are providing additional insights into optimal retreatment approaches, with patient-specific factors ultimately guiding individual treatment decisions.