Controversies and Unanswered Questions in CLL

In this engaging expert panel discussion from the 2nd Annual HemOnc Pulse Live, leaders in chronic lymphocytic leukemia (CLL) treatment explore the evolving landscape of frontline therapy, with a focus on the debate between continuous BTK inhibitor therapy and fixed-duration regimens. As new data emerge and clinical preferences shift, physicians are faced with the critical question: Which approach is best for which patient?

The panelists reflect on how treatment strategies have evolved from chemoimmunotherapy regimens—such as FCR, BR, and chlorambucil combinations—to today’s targeted therapies. They examine whether more intensive, time-limited combinations are appropriate for younger, fit patients, while continuous monotherapy may remain preferable for older or high-risk individuals.

Minimal residual disease (MRD) testing also takes center stage, with a detailed look at the value of MRD-4 vs MRD-6 sensitivity and how tools like flow cytometry and next-generation sequencing (NGS) are influencing remission depth assessment. The discussion acknowledges both the promise and limitations of MRD as a predictive tool and the complexities it adds to clinical decision-making.

The physicians also highlight patient-centered concerns, such as preferences for oral therapy over infusion, the burden of frequent clinic visits, and treatment adherence in community settings. The role of new data from studies like the AMPLIFY and MAGIC trials is dissected, especially regarding triple therapy combinations and their practical implications for deep remissions.

Ultimately, the panel underscores that personalized care remains key, and deeper remissions don’t always equate to longer progression-free survival—disease biology still drives outcomes.