Abstract
SummaryIn recent years, treatment of patients exhibiting chronic lymphocytic leukemia has changed extensively due to advances in the development of targeted therapies. The Bcl‑2 inhibitor venetoclax demonstrated outstanding results when used in mono- as well as combination therapy. Minimal residual disease (MRD) measurement has become an important endpoint in most studies and shows high prognostic potential. With upcoming combination strategies, the role of MRD measurement has also increased and is likely to become a routine marker in future clinical practice.
Highlights
Achieving undetectable minimal residual disease (MRD) at the end of combination treatment improved progression-free survival (PFS) and overall survival (OS) compared to patients who had detectable MRD
Three months after treatment completion, more patients in the venetoclax plus obinutuzumab group than in the chlorambucil plus obinutuzumab group were tested negative for MRD in peripheral blood as well as in bone marrow (75.5% vs 35.2% and 56.9% vs. 17.1%)
Three quarters of patients achieved a negative MRD result in peripheral blood when treated with venetoclax and obinutuzumab
Summary
In a phase 1 study of venetoclax, 17 of 23 patients who achieved complete remission (CR) were evaluated for MRD negativity, using at least 4-color FLC [5]. Of 70 patients in a phase 2 study with CR, 45 patients underwent peripheral MRD measurements and revealed a rate of 18 patients with MRD negativity, 6 out of 10 had no CLL cells detectable in the bone marrow. Achieving undetectable MRD (defined as < 1 CLL cell/10,000 leucocytes; < 10–4) at the end of combination treatment improved PFS and OS compared to patients who had detectable MRD.
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