What next after Acalabrutinib

[Hammerkev]

I am interested to learn what second line treatment options are available, in the UK or elsewhere, following Acalabrutinib as first line mono therapy. From CLL diagnosis and starting W&W in 2014 , I commenced Acalabrutinib in April 2021 following recovery from AIHA. I tolerate the medication reasonably well, experiencing mainly headaches and muscle cramps in varying degrees of intensity!

After a slow start there were significant improvements in blood counts until the end of 2022. Since then my white cell and lymphocyte counts have plateaued at the top of 'normal' range for the last 4 months, prompting my haematology consultant to raise the question of "what next"?

I am due my next clinic appointment in 2 weeks and am generally fit and well in CLL terms.

Any personal experience or information gratefully received.

Thank you.

[SofiaDeo]

You could do a search here of "CLL treatments" and see what people with diseases, symptoms, markers, like yours chose to do. There's nothing in your profile, and people have discussed the various treatments and the situations and markers and whatnot associated with their choices extensively. The UK NHS website may have a list of what their standard recommendations are.

[ornstin]

HiGoing on what you say I think there may be doubt as to whether the Acala has stopped working so I wonder whether the question you have posed may not be premature. Something you need to discuss with your consultant.

The second line NHS approved therapies would be :

1.Rituximab plus Venetoclax

2. Ibrutinib. The same type of drug as acalabrutinib so may be little point in you switching if it is really the case that acala not working for you

3. Probably a chemo combination could be given under the NHS as second line therapy.. Bearing in mind your age, this would probably be Bendamustine plus Rituximab (rather than FCR).

I know my consultant considers treatment 1 superior to treatment 3.

Lastly-the above is entirely subject to what your consultant says. He/she should be fully aware of what's available on the NHS.

It's also possible I may have omitted an available treatment but I can't think of one at present.

Regards

Antony

PS the above only relates to NHS treatments in the UK.

[Kwenda]

After Acalabrutinib you could try Pirtobrutinib which works slightly differently to Acalabrutinib and Zanubrutinib.

I believe there are world wide trials on the Pirtobrutinib and all results are positive.

Dick