Venetoclax Consolidation Achieves Durable Off-Treatment Remissions in Patient with High Risk CLL Who Have Been on Ibrutinib More Than a Year

[Jm954]

This is something that some of our USA members have discussed with their doctors and it looks like the logic is correct.

"Patients (pts) receiving ibrutinib (ibr) for CLL rarely achieve complete remission (CR) with undetectable minimal residual disease (U-MRD). Therefore, indefinite ibr maintenance therapy (Rx) is standard of care. Long-term Rx with ibr results in a cumulative risk of Rx discontinuation due to progression or toxicity.

The risk of progression is highest in pts with complex karyotype and/or del(17p); some series suggest increased risk in pts with del(11q) or persistently elevated β2-microglobulin.

Consolidation ven added to ibr in pts with high-risk CLL was well-tolerated and achieved cumulative BM U-MRD4 rate of 73% ibr discontinuation in 49% of pts. Only 1/45 pts progressed during combination Rx. At a median of 12 mo post-ven follow up, most pts who attained BM U-MRD have ongoing U-MRD in blood. A second cohort restricted to 45 high-risk pts with TP53abnormalities or complex karyotype is accruing and there are plans to also include patients treated with acalabrutinib."

From ASH Program: Oral and Poster Abstracts Type: Oral Session: 642. Chronic Lymphocytic Leukemia: ashpublications.org/blood/a...

Jackie

[CaptRon1976]

Jackie, help me understand the 73% of 49% phrase. Dr. Woyach at OSU spoke to me last year about the possibility of V consolidation therapy of my Acal. but didn’t go into it further. This is the first time I see the ASH report.

Ron

[Beattiem-UK]

Thanks for some good news Jackie. I'll be very interested to see the outcomes for TP53 patients.

[bennevisplace]

Excellent, thanks Jackie. So, time-limiting ibrutinib treatment limits the cumulative risk of Rx discontinuation due to progression, including the risk of ibrutinib resistance due to clonal evolution e.g. BTK mutation C481S?

[MovingForward4423]

it does seem these combinations are a win win for patients and the NHS. Remove the requirement for long term BTK,s, reduce costs and push patients into long deep remissions where they can remain treatment free. Maybe we are getting close to a cure, and only time will tell.