MURANO
MURANO showed that a fixed two-year course of the BCL2 inhibitor venetoclax with rituximab kept relapsed chronic lymphocytic leukaemia away for far longer than chemo-immunotherapy, and that many patients stayed in remission for years after stopping.
Overview
MURANO randomised 389 patients with relapsed or refractory chronic lymphocytic leukaemia to venetoclax for two years plus rituximab for the first six months, or to six cycles of bendamustine and rituximab. The primary endpoint was investigator-assessed progression-free survival.
Venetoclax-rituximab lengthened progression-free survival dramatically and produced far higher rates of undetectable minimal residual disease in blood and marrow, which predicted long remissions after therapy stopped. Overall survival also favoured the venetoclax arm with longer follow-up. The regimen was approved in the United States in June 2018 and made fixed-duration, chemotherapy-free treatment the model that the later CLL14 and CLL13 trials carried into first-line use.
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