Exploratory Results of PET-CT and Residual Lymph Node Fine Needle Aspiration of Patients Treated with First-Line Venetoclax and Ibrutinib for CLL/Sll; First Interim Analysis of the Phase 2 HOVON 158/Next STEP Trial

Levin, Mark‐David; Kersting, Sabina; Dubois, Julie; Norden, Yvette van; Dobber, Johan A.; Jauw, Yvonne W. S.; Kevie-Kersemaekers, Anne-Marie van der; Heer, Koen de; Burg, Leonie van der; Raa, Doreen te; Boer, Fransien de; Droogendijk, Jolanda; Idink, Cecile; Nijziel, Marten R.; Tick, Lidwine W.; Ludwig, Inge; Silbermann, Matthijs; Beeker, Aart; Bellido, Mar; Evers, Ludo M.; Zwezerijnen, Gerben J.C.; Niemann, Carsten Utoft; Kater, Arnon P.

doi:10.1182/blood-2022-163209

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“…The importance of lymph nodes in patients treated with venetoclax should also be considered in patients with clinical PR and MRD negativity, as recently shown in the interim analysis conducted on the cohort of the Phase 2 HOVON 158/Next STEP trial, 10 where patients in PR MRD negative showed the persistence of CLL cells in PET‐negative lymph nodes.…”

Section: Discussionmentioning

confidence: 97%

“…Therefore, these patients should be monitored closely to identify early signs of progression, even if the treatment change is still guided by iwCLL criteria 1 . In the future, in patients less previously treated or in the frontline setting, this observation needs to be further investigated, especially in novel treatment combinations of BTKi and venetoclax, in order to assess whether the synergic anti‐homing effect of the BTKi can overcome the persistence of residual disease in lymph nodes 10 …”

Section: Discussionmentioning

confidence: 99%

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Lymphadenopathy as a predictor of progression during venetoclax treatment in chronic lymphocytic leukemia. A campus chronic lymphocytic leukemia study

Autore

Innocenti

Reda

et al. 2023

Hematological Oncology

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Clinical or biological parameters useful to predict progression during treatment in real‐life setting with ibrutinib, idelalisib and venetoclax in relapsed/refractory chronic lymphocytic leukemia (CLL) are still debated. We conducted a multi‐center retrospective study on CLL patients treated with ibrutinib and/or idelalisib who were switched to venetoclax for progression or due to adverse events to identify any clinical and/or biological parameters useful to predict progression during treatment with venetoclax. Of all the 128 evaluable patients, 81 had received ibrutinib prior to switching to venetoclax, 35 had received idelalisib and 12 both. When comparing the three subgroups, we did not notice any statistical difference in terms of clinical or biological features. No variable at baseline and at different time points during the follow‐up (at 6, 12, 18 and 24 months) was found to predict progression nor to have significance for Progression Free Survival (PFS) in the ibrutinib group and in the idelalisib group and in subgroups according to the line of treatment. Analyzing the data of the venetoclax treatment, after a median follow up of 14.3 months, median PFS was not reached and estimated 3‐year PFS was 54%. Of the 128 patients treated with venetoclax, 28 (22%) experienced progressive disease. At multivariate analysis for predictive factors for progression, lymph node diameter >56.5 mm before starting treatment emerged as an independent risk factor for progression. The lymph node predictive role for progression during venetoclax treatment could be a new parameter that deserves to be investigate in future studies.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%