Chronic lymphocytic leukemia therapy guided by measurable residual disease

Prior data has shown that patients with CLL prefer time-limited therapy, and authors of this study found that use of measurable residual disease (MRD) to guide length of time-limited combination targeted therapy with ibrutinib plus venetoclax resulted in improved progression-free survival (PFS) compared to time-limited chemoimmunotherapy with FCR for patients with CLL. The study, presented at ASH, found that at a median of 43.7 months, disease progression or death occurred in 12 patients in the ibrutinib-venetoclax group and in 75 patients who received fludarabine, cyclophosphamide, and rituximab (FCR). Both progression-free survival and overall survival rates at 3 years favored ibrutinib-venetoclax (76.8% vs. 97.2% and 98.0% vs. 93.0%). At 5 years, 65.9% of the patients in the ibrutinib-venetoclax group had undetectable MRD in bone marrow and 92.7% had undetectable MRD in peripheral blood, suggesting that an MRD-guided approach to fixed-duration ibrutinib plus venetoclax can result in durable remissions.