Relapsed or refractory chronic lymphocytic leukaemia: lines of therapy
3 standard-of-care settings across 2 lines and 2 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Relapse after a BTK inhibitor | Venetoclax plus rituximab for two years (MURANO) or venetoclax-obinutuzumab; pirtobrutinib after covalent BTK inhibitor failure (BRUIN CLL-321). | NCCN Guidelines: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma | 86 | |
| All comers | Relapse after venetoclax | Acalabrutinib or zanubrutinib (ALPINE) continuously, or ibrutinib; venetoclax retreatment if the prior remission lasted a year or more. | NCCN Guidelines: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma | 95 |
Third line and beyond
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| FRα | Double-refractory after BTK inhibitor and venetoclax | Pirtobrutinib; lisocabtagene maraleucel CAR-T (TRANSCEND CLL 004); idelalisib-rituximab; clinical trials of BTK degraders, sonrotoclax and bispecifics; allogeneic transplant in fit young patients. | NCCN Guidelines: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma | 92 |
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.