Dr. Brander on the Role of MRD Negativity With Venetoclax-Based Regimens in CLL

Danielle M. Brander, MD, assistant professor of medicine, Department of Medicine, Duke University School of Medicine, hematologic oncologist and hematologist (malignant), Duke Cancer Center, Duke Health, discusses the role of achieving minimal residual disease (MRD) negativity with venetoclax (Venclexta)-based regimens in chronic lymphocytic leukemia (CLL).

Achieving MRD negativity is desirable and achievable in patients with high-risk CLL who require deep remissions, Brander says. Moreover, achieving MRD negativity is a goal of treatment with time-limited venetoclax-based regimens, including venetoclax plus obinutuzumab (Gazyva) for 12 months in newly diagnosed CLL or venetoclax plus rituximab (Rituxan) for 24 months in the relapsed/refractory setting.

With these regimens, data have suggested that patients who achieve MRD negativity by the end of treatment have prolonged progression-free survival and, potentially, overall survival, Brander explains.

As expected, investigational combination regimens of BTK inhibitors plus venetoclax or obinutuzumab appear to induce higher rates of MRD negativity, but at the expense of added toxicity to patients, Brander says. Although the data with these combinations are encouraging, it is important to consider the patient’s goal of therapy before selecting a potentially more toxic regimen with the hope of achieving MRD negativity, Brander concludes.