Ref Blood Oct 2025
Newly diagnosed CLL needing rx
- TP53 status
- IGHV status
- Indication for rx:
- Cardiac hx, HTN, DOAC, bleeding hx or dual antiplatelets
Double refractory
- Prognosis PFS 7 months, OS 2 yr
- 2 treatment options: pirtobrutinib and anti- CD 19 CAR- T Lisocel
1. Important to differentiate between true refractory versus exposed to these agents for limited time and or intolerance as a reason for stopping.
2. Obtain bx and mutation at progression to rule out Richter
3. Pirtobrutinib has an ORR of80% but responses last 15 months so best to start with this and plan on Lisocel. Lisocel has CR of 20%
4. Do not discontinue BTK i immediately upon progression until there is access to the next line of treatment
5. For those who progress after CAR-T , allo SCT provided they have at least a PR
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