Living with cll

[Skyfallmoon]

Hello everybody.My husband has been living with cll for 12 years.Five years ago has started the treatmant with Ibrutinib.It went well until now.We don t know yet what our doctor will suggest for second line of fherapy.My husband has 11q deletion.Has anybody some advice?Thank you and be well!

[BigfootT]

What issue is he having? Tolerability or disease progression?

Bigfoot

[Skyfallmoon in reply to BigfootT]

Disease progression.The last 2 months seems that the white cells are growing.

[BigfootT]

Absolute lymphocyte count is the most important number vice the WBC, but if he is progressing I think Pirtobrutnib (ncBTKi) or a BCL2 target (Venetoclax + Anti CD20) are possible options, but I'm not a medical expert and don't know your husband's specifics. He also could be a candidate for a clinical trial with one of the new targets.

Bigfoot

[Skyfallmoon]

Thank you very much! This week will meet our doctor and we will discuss this option.Our doctor said something about Acalabrutinib.What do you think?

[AussieNeil Partner Administrator in reply to Skyfallmoon]

Acalabrutinib, zanubrutinib and ibrutinib all bond to the BTK enzyme in CLL cells the same way - covalently. A switch to acalabrutinib or zanubrutinib makes sense if your husband can no longer tolerate ibrutinib, as they are better tolerated. However, it won't help him if the ibrutinib is no longer working, that is, if his CLL is developing resistance to ibrutinib. Pirtobrutinib bonds non-covalently, so should work in that case, but generally doesn't work as long as ibrutinib. Therefore it's more usual to switch to venetoclax, perhaps coupled with another drug for a fixed duration treatment when resistance develops to ibrutinib.

Neil

[Skyfallmoon in reply to AussieNeil]

Thank you very much for this information . Tomorrow we have an appointment with our doctor and he will make some tests to see exactly if he should change the therapy.For 5 years with Ibrutinib the tests results were good.2 months ago the white cells begun to increase and we are serching the cause.His health is good there are not other simpoms.

[Nucleusman]

try acalabrutinib also called Calquence

[Thebessttiiyretui in reply to Nucleusman]

Like Neil says, Acalabrutinib is the same class as Ibrutinib and if he has become resistant to Ibrutinib, he will be unlikely to respond to Acalabrutinib. If this is what your doctor wants to do, I would get a second opinion.

[Nucleusman]

take advice of experienced haematologist