Infection Risk With Obinutuzumab and Retreatment After Fixed-Duration Therapy

Sameh Gaballa, MD, of Moffitt Cancer Center, notes that infection rates in CLL17 were higher in the venetoclax plus obinutuzumab arm and asks how that shapes treatment selection in chronic lymphocytic leukemia (CLL). M. Yair Levy, MD, of Texas Oncology–Baylor Charles A. Sammons Cancer Center, says decisions weigh efficacy, safety, tolerability, and logistics against the patient’s goals. He gives intravenous immunoglobulin when immunoglobulin G falls below 400 or recurrent mucocutaneous infections occur, places most patients on antiviral prophylaxis, and rarely uses Pneumocystis prophylaxis unless steroids are involved. On relapse after fixed-duration therapy, Andrew H. Lipsky, MD, of Columbia University Irving Medical Center, finds the ReVenG retreatment data very good and will retreat a patient who had 2 years off therapy, sometimes with venetoclax alone in older patients. Dr Levy removes only agents a patient has progressed on, such as a second covalent Bruton tyrosine kinase inhibitor after covalent failure.