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Expert Reviews CLL Advances Presented at ASH

Danielle Bucco
Published: Thursday, Apr 05, 2018

Alan Skarbnik, MD

Alan Skarbnik, MD
The 2017 ASH Annual Meeting provided physicians with numerous updates for the treatment of patients with chronic lymphocytic leukemia (CLL), leaving experts to predict what regulatory advances could take place in the near future.

on Hematologic Malignancies, Skarbnik, staff physician, Department of Bone Marrow Transplant, Department of Lymphoma, John Theurer Cancer Center, shared his insight on the latest updates in CLL presented at the 2017 ASH Annual Meeting.

OncLive®: What is the current state of CLL?

Skarbnik: Newer combinations are coming along improving response rates, survival rates, and PFS rates for patients. We are looking at the evidence suggesting the importance of minimal residual disease (MRD)-negativity in CLL. We can have long-term treatment-free intervals for some patients, but since the novel therapies need to be given continuously, we are looking to stop it earlier.

Can you speak to some of the combination data that were presented at ASH?

The biggest splash at the 2017 ASH Annual Meeting was the MURANO trial. It is a phase III trial for patients with relapsed CLL independent of cytogenetics and they must have had at least 1 chemotherapy-containing line of therapy to be enrolled in the trial. Patients were randomized to either BR, which is one of the standards of care for CLL, or venetoclax plus rituximab. BR was given in the usual fashion for 6 cycles; however, in the venetoclax/rituximab combination, rituximab was given for 6 months—starting after the ramp-up of venetoclax—but venetoclax had a finite therapy time of 2 years. Patients stayed on the drug for 2 years but if they progressed or had an unacceptable toxicity, they stopped sooner. This is different to how venetoclax has been approved, which is continuous until disease progression.
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