Approach to relapsed CLL including Richter Transformation

Consensus Statements Highlight the Need of Harmonizing Chronic Lymphocytic Leukemia Management Worldwide

“…Alshemmari et al [1] consistently highlight the association of acalabrutinib and obinutuzumab amongst the preferred upfront treatment options. In contrast, a single agent BTKi continues to be the gold standard of treatment for relapsed/ refractory (R/R) CLL as the combination of a BTKi with an anti-CD20 monoclonal antibody is not supported by phase III clinical trial data in the context of R/R disease [5].…”

“…Another reason for the decline of allo-HCT use is that the traditional definition of high-risk disease mainly based on the presence of TP53 aberrations has lost some relevance in the era of targeted agents. For these reasons, the role of allo-HCT is well-defined only in the context of Richter transformation [4,5].…”

“…Of note, double-refractory CLL patients and especially those who are penta-refractory (previous covalent BTKi, chemotherapy, CD20 antibody, BCL2i, and PI3Ki) have no accepted standard-of-care therapy available. Since available information indicates that pirtobrutinib, a non-covalent BTKi, is an effective option for double-refractory patients, an FDA and EMA accelerated approval of pirtobrutinib is expected in CLL [5].…”