Caution: chemoimmunotherapy in del(17p)/TP53 CLL
Chemotherapy-based regimens barely work when the p53 gene is lost; these patients need BTK inhibitors or venetoclax from the start.
FCR and BR give short remissions (median PFS ~1 year) in del(17p)/TP53-mutated CLL and may select resistant clones. Guidelines (NCCN, ESMO, iwCLL) restrict chemoimmunotherapy to TP53-intact, IGHV-mutated, fit patients, and even there targeted therapy is preferred.
Pages like this
not linked directly; found by shared links- Key paperMURANO: two years of venetoclax plus rituximab versus chemo-immunotherapy in relapsed CLL
Shares del(17p) / TP53 aberration in CLL, Rituximab, Venetoclax, Chronic lymphocytic leukaemia.
- PairingBTK inhibitor + venetoclax, fixed duration
Shares SEQUOIA, Zanubrutinib, Venetoclax, Chronic lymphocytic leukaemia.
- TrialCELESTIAL-TNCLL
Shares Zanubrutinib, Venetoclax, Chronic lymphocytic leukaemia.
- Key paperELEVATE-TN: acalabrutinib, alone or with obinutuzumab, against chemo-immunotherapy in untreated CLL
Shares SEQUOIA, Zanubrutinib, Chronic lymphocytic leukaemia.
- TrialAMPLIFY
Shares del(17p) / TP53 aberration in CLL, Venetoclax, Chronic lymphocytic leukaemia.
- IdeaMRD-guided treatment duration in CLL
Shares Zanubrutinib, Venetoclax, Chronic lymphocytic leukaemia.
- TrialALPINE
- PairingCaution: ibrutinib in patients with cardiac risk