Treatment Selection at Relapse in CLL

Dr. Mazyar Shadman introduces the discussion on treatment selection and sequencing in relapsed/refractory chronic lymphocytic leukemia (CLL), joined by Dr. Jennifer J. Huang. The experts outline how prior treatment exposure, duration of response, reasons for treatment discontinuation, and emerging resistance patterns influence subsequent treatment decisions. Dr. Huang explains how the distinction between disease progression and intolerance to a covalent Bruton tyrosine kinase (BTK) inhibitor can guide treatment selection. For patients who discontinue a covalent BTK inhibitor because of intolerance, another agent within the same class may be considered. However, progression during treatment may indicate resistance, prompting consideration of a different therapeutic class or a noncovalent BTK inhibitor. The discussion also highlights the importance of response duration following fixed-duration venetoclax-based therapy when evaluating retreatment versus switching to another treatment approach.