Modern strategies for the treatment of chronic lymphocytic leukaemia – the importance of fixed-duration regimens and their reuse

Czech version

Authors: M. Šimkovič; D. Écsiová; P. Vodárek
Authors‘ workplace: IV. interní hematologická klinika FN Hradec Králové
Published in: Transfuze Hematol. dnes,31, 2025, No. 3, p. 176-179.
Category: Review/Educational Papers
doi: https://doi.org/10.48095/cctahd2025prolekare.cz19

Overview

The introduction of fixed-duration therapy regimens marks a significant advance in the treatment of chronic lymphocytic leukaemia (CLL), as it enables the attainment of deep remissions without the need for continuous medication. Combinations of targeted agents –⁠ particularly venetoclax with obinutuzumab or a Bruton’s tyrosine kinase inhibitor –⁠ demonstrate high efficacy and a favourable safety profile, offering patients the opportunity for so called “treatment holidays”. This approach is not only clinically effective, but also cost efficient. Increasingly, attention is turning to the possibility of re administration of these regimens in the event of relapse, i.e. retreatment. Available data from the MURANO study and real world practice suggest that venetoclax based retreatment may be both efficacious and safe in selected patients, particularly where relapse occurs after a prolonged remission. This strategy is now reflected in both Czech and international clinical guidelines, which recommend retreatment as a suitable option for patients whose response lasted for at least one to two years following completion of therapy. In summary, fixed duration regimens constitute an effective and modern approach to CLL management, and the potential for their repeated use opens new horizons for sequential therapy in clinical practice. As the existing evidence is drawn mainly from retrospective analyses and limited cohorts, prospective trials with clearly defined design and long term follow up are needed to definitively confirm the efficacy and safety of this strategy.

Keywords:

venetoclax – chronic lymphocytic leukaemia – retreatment – fixed-duration therapy

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PROHLÁŠENÍ O MOŽNÉM KONFLIKTU ZÁJMŮ

MŠ obdržel honoráře za konzultační činnost, účast v poradních sborech, cestovní granty a další odměny od společností AbbVie, AstraZeneca, Eli Lilly Johnson & Johnson, Merck Sharp & Dohme, a Swix BioPharma; DÉ obdržela honoráře za konzultační činnost, cestovní granty a další odměny od společností AbbVie, AstraZeneca, Johnson & Johnson a Swix BioPharma; PV obdržel honoráře za konzultační činnost, cestovní granty a další odměny od společností Roche, Gilead, AstraZeneca, Eli Lilly, Johnson & Johnson, Takeda, AbbVie, Servier, Celgene a Swix BioPharma.

PODÍL AUTORŮ NA PŘÍPRAVĚ RUKOPISU

MŠ sepsal rukopis, PV a DÉ revidovali rukopis.

PODĚKOVÁNÍ

Podpořeno programem Cooperatio, vědní oblast ONCO, projektem RVO MZ ČR (FNHK 00179906) a společností AbbVie.

Do redakce doručeno dne: 8. 4. 2025.

Přijato po recenzi dne: 21. 7. 2025.

MUDr. Martin Šimkovič, Ph.D.

IV. Interní hematologická klinika

FN Hradec Králové

Sokolská 581

500 05 Hradec Králové

e-mail: simkovicm@lfhk.cuni.cz