علاج سرطان الدم الليمفاوي المزمن مع طفرة TP53 و/أو حذف 17p لدى المرضى غير المُعالَجين سابقاً

References

• First-line treatment options for CLL patients with TP53 disruption include BTKi treatment and venetoclax monotherapy (the latter only where BTKi are contraindicated).
• Continuous cBTKi regimens may be preferred over fixed-duration regimens due to the longer responses observed in this setting (GRADE 2A).
• Among continuous treatment options, second-generation cBTKi (acalabrutinib or zanubrutinib) are preferred to ibrutinib due to their improved safety profile (GRADE 1A).
• Ibrutinib is not recommended for new treatment initiation but may be continued in patients already receiving it and tolerating it well.
• Acalabrutinib–obinutuzumab (A+O, MHRA [no NICE TA/SMC], FDA, EMA) is a first-line option for patients with TP53 disruption (GRADE 1B).
• Venetoclax monotherapy remains an option for patients for whom a BTKi or idelalisib–rituximab is contraindicated (GRADE 2B).
• Idelalisib–rituximab is least preferred due to higher toxicity (GRADE 2A).