Results of a phase 3 study of IVO vs IO for previously untreated older patients (pts) with chronic lymphocytic leukemia (CLL) and impact of COVID-19 (ALLIANCE)

Data presented at the 2023 ASCO Annual Meeting from the Alliance trial showed that triplet therapy with ibrutinib, obinutuzumab, and venetoclax was not superior to doublet therapy with ibrutinib and obinutuzumab for previously untreated older patients during the COVID-19 pandemic. Researchers looked at 431 evaluable patients of 465 registered to the trial, with a median age of 74. Of the 431, 67% were men, 55% had a Rai stage of 3-4, and 13% had del17p genomic aberrations. The median follow-up was 14 months, and the progression-free survival was 85% vs. 87.5%, respectively. For those patients receiving triplet therapy, there were 35 total events, with 7 patients experiencing disease progression and 28 deaths; 29 patients on doublet arm experienced disease progression (n = 4), death (n = 23), or started a different therapy (n = 2). The leading cause of death in both arms was COVID-19 (19 vs. 11, respectively). Rates of grades 3 and 4 toxicity, as well as treatment discontinutation within the first year of therapy, were similar for both arms. It is unclear how much the Covid-19 pandemic may have confounded these results, but at this time this study does not support use triplet therapy with ibrutinib, venetoclax, and obinutuzumab in the frontline setting of CLL in older adults.