Chronic Lymphocytic Leukemia Therapy Guided by Measurable Residual Disease

This phase 3 randomized trial compared MRD guided ibrutinib venetoclax therapy to standard fludarabine cyclophosphamide rituximab (FCR) in previously untreated chronic lymphocytic leukemia (CLL). The MRD guided approach allowed treatment duration to be personalized based on how quickly patients achieved undetectable MRD. Results showed significantly improved progression free survival and overall survival with ibrutinib venetoclax, especially in patients with unmutated IGHV. At 3 years, 58% of patients had stopped therapy due to MRD clearance. Safety profiles were favorable, though cardiac events were more frequent in the ibrutinib venetoclax group. The study supports MRD guided therapy as a promising strategy for individualized treatment in CLL.

This phase 3 randomized trial compared MRD guided ibrutinib venetoclax therapy to standard fludarabine cyclophosphamide rituximab (FCR) in previously untreated chronic lymphocytic leukemia (CLL). The MRD guided approach allowed treatment duration to be personalized based on how quickly patients achieved undetectable MRD. Results showed significantly improved progression free survival and overall survival with ibrutinib venetoclax, especially in patients with unmutated IGHV. At 3 years, 58% of patients had stopped therapy due to MRD clearance. Safety profiles were favorable, though cardiac events were more frequent in the ibrutinib venetoclax group. The study supports MRD guided therapy as a promising strategy for individualized treatment in CLL.