Strategy for selecting treatment of R/R CLL
| Prior treatment . | Recommendation for next treatment . | Allo-SCT planning . | ||
|---|---|---|---|---|
| CIT . | BCL2i . | BTKi . | ||
| Yes | No | No | VEN + RIT (fixed duration) or BTKi (continuous) | No |
| Yes (intolerant) | Alternative BTKi (continuous) or PI3Ki ± CD20 mAb (continuous) | No | ||
| Yes (refractory) | VEN + RIT | Short-term | ||
| Yes | No | BTKi (continuous) | Yes | |
| Yes (intolerant) | Alternative BTKi (continuous) or PI3Ki ± CD20 mAb (continuous) | Yes | ||
| Yes (refractory) | Clinical trial CIT if no TP53 abnormality to debulk | Immediate | ||
| No | No | Yes (intolerant) | Alternative BTKi (continuous) or PI3Ki ± CD20 mAb (continuous) | No |
| Yes (refractory) | VEN + RIT (fixed duration) | Yes | ||
| Yes | No | BTKi (continuous) | No | |
| Yes (intolerant) | Alternative BTKi (continuous) or PI3Ki ± CD20 mAb (continuous) | No | ||
| Yes (refractory) | Clinical trial CIT if no TP53 abnormality to debulk | Immediate | ||
| Prior treatment . | Recommendation for next treatment . | Allo-SCT planning . | ||
|---|---|---|---|---|
| CIT . | BCL2i . | BTKi . | ||
| Yes | No | No | VEN + RIT (fixed duration) or BTKi (continuous) | No |
| Yes (intolerant) | Alternative BTKi (continuous) or PI3Ki ± CD20 mAb (continuous) | No | ||
| Yes (refractory) | VEN + RIT | Short-term | ||
| Yes | No | BTKi (continuous) | Yes | |
| Yes (intolerant) | Alternative BTKi (continuous) or PI3Ki ± CD20 mAb (continuous) | Yes | ||
| Yes (refractory) | Clinical trial CIT if no TP53 abnormality to debulk | Immediate | ||
| No | No | Yes (intolerant) | Alternative BTKi (continuous) or PI3Ki ± CD20 mAb (continuous) | No |
| Yes (refractory) | VEN + RIT (fixed duration) | Yes | ||
| Yes | No | BTKi (continuous) | No | |
| Yes (intolerant) | Alternative BTKi (continuous) or PI3Ki ± CD20 mAb (continuous) | No | ||
| Yes (refractory) | Clinical trial CIT if no TP53 abnormality to debulk | Immediate | ||
Allo-SCT, allogeneic stem cell transplant; BCL2i, BCL2 inhibitor; mAb, monoclonal antibody; PI3Ki, PI3K inhibitor.