Optimal Frontline Therapy for Young or Fit Patients with Chronic Lymphocytic Leukemia: A Case-Based Discussion

Abstract

Introduction Standard chemotherapy regimens, such as the combination of fludarabine, cyclophosphamide, and rituximab (FCR), previously held a long-standing recommendation as the standard of care for frontline CLL therapy, especially for young and fit patients with CLL. With the introduction of targeted kinase inhibitors, such as ibrutinib [Bruton’s tyrosine kinase inhibitor (BTKi)], acalabrutinib (BTKi), and venetoclax [B-cell lymphoma-2 inhibitor (BCL-2i)], this recommendation has evolved over the last decade to incorporate the use of these agents in this population. Young and fit CLL patients are loosely defined as patients under the age of 65 years and those with a Cumulative Illness Rating Scale ≤6 and creatinine clearance ≥70 ml/min.1,2 This abstract will discuss the management of two young, fit patients who require frontline CLL therapy.