Time-Limited Therapy, MRD, and Treatment Discontinuation

This segment focuses on the growing role of time-limited therapy in CLL, especially as venetoclax-based regimens and newer combinations demonstrate deep remissions with finite treatment durations. The discussion examines how clinicians think about stopping therapy, the use of minimal residual disease (MRD) as a potential biomarker to guide duration, and the uncertainties that still exist in determining optimal endpoints.

Panelists describe how MRD testing, although not universally adopted, offers valuable prognostic insight: patients achieving undetectable MRD tend to maintain long remissions after discontinuing venetoclax-based therapy. However, they caution that MRD-guided stopping strategies lack consensus and standardized implementation in community settings. While appealing, MRD-based adaptation requires greater trial maturity before widespread adoption.

The experts also emphasize patient experience and quality of life. Time-limited therapy is often preferred by patients who want treatment-free intervals, fewer clinic visits, or who struggle with the idea of lifelong therapy. The panel notes that patients who achieve deep remissions frequently enjoy lengthy off-treatment periods, reinforcing the appeal of venetoclax-based approaches.

Another theme is the challenge of predicting relapse and monitoring patients after discontinuation. The panel stresses that close clinical follow-up, including periodic labs and symptom assessment, helps identify early signs of disease progression without overtreatment. Real-world practice varies, but active surveillance is key.

The segment concludes by comparing time-limited versus continuous BTKi therapy, noting that while BTKis maintain disease control effectively, they commit patients to indefinite daily treatment. The choice between strategies reflects both clinical and personal priorities, and the field continues to evolve as new data emerges.