Immune Reconstitution After Fixed-Duration Venetoclax-Based Therapy

Danielle M. Brander, MD, of Duke University School of Medicine, outlines frontline options in chronic lymphocytic leukemia (CLL), continuous Bruton tyrosine kinase (BTK) inhibitors with or without anti-CD20 antibodies versus fixed-duration venetoclax plus obinutuzumab, and asks what immune recovery looks like once fixed-duration therapy ends. Antibody levels, T cells, and B cells recover on different schedules: in the relapsed/refractory MURANO trial, B-cell recovery began about a year after treatment and stabilized around 30 months, and in a frontline venetoclax plus obinutuzumab study immunoglobulins began recovering around 9 months while B-cell counts stayed below baseline about 2 years out. Marc J. Braunstein, MD, PhD, of NYU Grossman Long Island School of Medicine, tells patients they are not out of the woods after treatment, especially after obinutuzumab, which can delay B-cell recovery for years; his team tells patients to report fevers or infectious symptoms and expects 6 to 12 months before infection risk meaningfully falls.