Outcomes of patients with CLL sequentially resistant to both BCL2 and BTK inhibition
- Author(s)
- Lew, TE; Lin, VS; Cliff, ERS; Blombery, P; Thompson, ER; Handunnetti, SM; Westerman, DA; Kuss, BJ; Tam, CS; Huang, DCS; Seymour, JF; Roberts, AW; Anderson, MA;
- Journal Title
- Blood Advances
- Publication Type
- epub ahead of print
- Abstract
- Covalent Bruton tyrosine kinase inhibitors (BTKis) and the BCL2 inhibitor venetoclax have significantly improved outcomes for patients with chronic lymphocytic leukemia (CLL), especially those with biologically adverse disease. Patients with CLL resistant to their first targeted agent (TA) can be effectively treated with the alternative class. However, relapses are expected with second-line TA therapy, and the clinical challenge of double class-resistant disease is now emerging with increasing frequency. To define the characteristics and outcomes of patients with double class-resistant disease, we retrospectively analyzed 17 patients who developed progressive disease (PD) on both TA classes for CLL (venetoclax, then BTKi, n=12; BTKi, then venetoclax, n=5). The cohort was heavily pre-treated (median lines of prior therapy: 4) and enriched for adverse disease genetics (complex karyotype: 12/12 tested, 100%; del(17p)/TP53 mutations: 15/17, 88%). The median time to progression on prior venetoclax was 24 (range 6-94) months, and on prior BTKi was 25 (range 1-55) months. Progression on second-line TA was manifest as progressive CLL in 11 patients and as Richter transformation in six. The median overall survival after progression on second-line TA was 3.6 (95%CI 2-11) months. Patients with double class-resistant CLL have a dismal prognosis, representing a group of high unmet need.
- Publisher
- ASH
- Research Division(s)
- Blood Cells And Blood Cancer
- PubMed ID
- 34478505
- Publisher's Version
- https://doi.org/10.1182/bloodadvances.2021005083
- Open Access at Publisher's Site
https://doi.org/10.1182/bloodadvances.2021005083- Terms of Use/Rights Notice
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Creation Date: 2021-09-17 11:23:16
Last Modified: 2021-09-17 11:47:08