علاج CLL النشط مع حالة IGHV غير المتحورة في المرضى اللائقين طبياً بدون طفرة TP53 أو del(17p)

References

Condition:

• CLL with unmutated IGHV status and without TP53 mutation or del(17p) (if there was similar efficacy, panel is giving preference to time-limited therapies).
• Fit patients: ibrutinib [I, A] (data for other BTKis for fit patients are still pending); CIT should be avoided due to survival disadvantage, but may be used if other options are not available [I, A]. Venetoclax plus obinutuzumab might be an alternative to BTKis, but data for fit patients are still pending [III, A].

Treatment:

• Allogeneic stem cell transplantation (alloSCT) should be considered in: Patients refractory to CIT and to novel inhibitor therapy, even for patients with a higher risk of non-relapse mortality [haematopoietic cell transplant comorbidity index (HCT-CI) score of 3] [III, B].
• Treatment with chimeric antigen receptor T (CAR-T) cells or bi-specific T-cell engager (BiTE) antibodies within clinical trials could be an alternative to alloSCT for all three groups [V, B].