Dr Woyach on When to Initiate Subsequent Therapy in Patients With CLL

“[Initiating subsequent therapy in patients with CLL] depends on the [prior] therapy…For patients on a covalent BTK inhibitor, we generally see that [disease] relapses occur slowly at first. We may see months, maybe even a year, of just increasing lymphocyte count.”

Jennifer A. Woyach, MD, coleader of the Leukemia and Hematologic Malignancies Program and a professor in the College of Medicine at The Ohio State University Comprehensive Cancer Center–James, discusses when additional therapy should be initiated for the treatment of patients with chronic lymphocytic leukemia (CLL).

Woyach began by underscoring that subsequent therapy for patients with relapsed/refractory CLL is largely dependent on the prior therapy that they received. Patients who are first treated with a covalent BTK inhibitor tend to experience slower disease relapse compared with those treated with other agents in the frontline, she explained. Increasing lymphocyte count can occur in these patients over the course of months or even up to a year, she added. For patients who only display an increasing lymphocyte count with no other signs of recurrent disease, Woyach will hold further treatment until other signs of disease progression emerge, she said.

For patients treated with a fixed-duration regimen in the frontline setting, the same criteria are generally required to begin second-line treatment, Woyach explained. This includes waiting until symptom onset; however, waiting as long as one would for their first therapy is not always ideal because it is understood that the patient will need additional therapy at some point, Woyach noted.

Treatment in the third line and beyond should not be held until additional symptoms develop, Woyach said. In this setting, any signs of disease progression indicate that a patient should switch to a new therapy when it is convenient for them, she concluded.