Risk Stratification and Advances in CLL Management. How to Choose Best BTK Inhibitor for CLL Patient?

The treatment landscape of chronic lymphocytic leukemia (CLL) has changed significantly with the introduction of targeted therapies like Bruton tyrosine kinase inhibitor (BTKi) and BCL-2 inhibitor (venetoclax). At diagnosis, patients are stratified into four groups according to CLL-IPI. Targeted therapy has been proven to be more effective than chemoimmunotherapy even in high-risk group patients defined by unmutated IGHV, deletion 17p (17p-), and mutation TP53. While monotherapy with BTKi is an excellent option for many patients, combination therapies can induce deep and durable remissions. There are several doublet therapies that are currently in clinical use. These include combinations of BTKi with BCL2 inhibitors (venetoclax). Triplets combine BTKi with venetoclax and CD20 inhibitors. Selecting proper treatment depends on the patient’s co-morbidities, concomitant use of other drugs, cost, and the patient’s preference.