Clinical Perspectives: BTKi Treatment-Related Adverse Effects in Relapsed CLL

This educational program focuses on shared decision-making in chronic lymphocytic leukemia (CLL) treatment, emphasizing the balance between safety, efficacy, and patient preferences. The discussion centers around Bruton tyrosine kinase inhibitor (BTKi) treatment approaches, particularly examining class-related and unique adverse events associated with these therapies. The program also aims to compare efficacy and safety data between first- and second-generation BTKis in both frontline and relapsed/refractory settings.

The case study presented involves a patient who received bendamustine and rituximab chemotherapy in 2020, which the experts noted was somewhat outdated even at that time, as newer targeted therapies had been available since 2016. Despite this, the patient achieved a reasonable remission duration, likely due to the absence of high-risk features initially. However, upon disease progression, the patient developed concerning features including a 17p deletion, which significantly impacts treatment selection and prognosis.

For the relapsed setting with high-risk features like 17p deletion, the experts strongly favor BTKi therapy over venetoclax-based regimens. They emphasize that patients with 17p deletion demonstrate particularly favorable outcomes with BTKis , making this the preferred therapeutic approach. The discussion highlights an ongoing challenge in clinical practice, where approximately 20% of patients still receive chemoimmunotherapy despite the superior outcomes demonstrated with newer targeted agents, underscoring the importance of continued medical education and awareness efforts.