Dr. Bociek on the Role of MRD in CLL

R. Gregory Bociek, MD, an associate professor of internal medicine, Division of Oncology and Hematology and program director, Hematology/Oncology Fellowship Program, University of Nebraska Medical Center, discusses the role of minimal residual disease in patients with chronic lymphocytic leukemia (CLL).

One trial that examined the role of MRD in CLL was the phase 2 CAPTIVATE trial (NCT02910583), where patients with CLL received 3 cycles of ibrutinib (Imbruvica), followed by 12 cycles of the combination ibrutinib plus venetoclax (Venclexta). After 12 months of treatment with the combination, patients are assessed for MRD; those who are confirmed to have undetectable MRD are then randomized to either continue ibrutinib or placebo, Bociek explains.

To answer the question of whether putting patients with undetectable MRD on more treatment, which comes with added cost and toxicity, is beneficial, Bociek notes. This study will help to clarify whether this patient population needs more therapy after initial induction, Bociek says. Additionally, patients who do have MRD on this trial will be randomized to either single-agent ibrutinib or continuation of the ibrutinib/venetoclax combination. The outcomes observed with these approaches will help guide future therapy decisions, Bociek concludes.