A Patient-Centered Approach: Treatment Strategies for Progression and Intolerance in R/R CLL - Episode 1
Clinical Perspectives: 59yF with R/R CLL after Time-Limited Therapy
Panelists discuss how a CLL patient with initially low-risk disease and mutated IGHV unexpectedly relapsed early after venetoclax-obinutuzumab treatment with acquisition of high-risk features, presenting unique management challenges.
Initial Case Assessment and Unexpected Disease Progression
This segment presents a challenging chronic lymphocytic leukemia (CLL) case involving a patient who initially had low-risk disease features including mutated IGHV, deletion 13q, and wild-type p53. Despite achieving deep minimal residual disease (MRD) negative remission with venetoclax-based treatment, the patient experienced an unusually short relapse period.
Upon relapse, the disease acquired high-risk features including deletion 17p and p53 mutations, which is uncommon for patients who start with favorable prognostic markers. The experts emphasize the importance of karyotype testing to explain why relatively low-risk patients might progress unexpectedly or not respond optimally to treatment.
Treatment decisions for this young patient with newly acquired high-risk features include several options: retreatment strategies, continuous BTK inhibitor therapy, or combination approaches using BTK and BCL-2 inhibitors. The case represents a unique clinical scenario requiring careful consideration of next-line therapy options given the patient's age and evolving disease characteristics.
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