Undetectable peripheral blood MRD should be the goal of venetoclax in CLL, but attainment plateaus after 24 months
AuthorLew, TE; Anderson, MA; Lin, VS; Handunnetti, SM; Came, NA; Blombery, P; Westerman, DA; Wall, M; Tam, CS; Roberts, AW; ...
Source TitleBlood Advances
PublisherAMER SOC HEMATOLOGY
University of Melbourne Author/sCame, Neil; Westerman, David; Seymour, John; Roberts, Andrew; Tam, Constantine; Wall, Meaghan; Handunnetti, Sasanka; Anderson, Mary Ann; Blombery, Piers
AffiliationMedicine and Radiology
Centre for Cancer Research
Sir Peter MacCallum Department of Oncology
Medical Biology (W.E.H.I.)
Document TypeJournal Article
CitationsLew, T. E., Anderson, M. A., Lin, V. S., Handunnetti, S. M., Came, N. A., Blombery, P., Westerman, D. A., Wall, M., Tam, C. S., Roberts, A. W. & Seymour, J. F. (2020). Undetectable peripheral blood MRD should be the goal of venetoclax in CLL, but attainment plateaus after 24 months. BLOOD ADVANCES, 4 (1), pp.165-173. https://doi.org/10.1182/bloodadvances.2019000864.
Access StatusAccess this item via the Open Access location
Open Access URLhttp://doi.org/10.1182/bloodadvances.2019000864
The highly selective BCL2 inhibitor venetoclax achieves deep responses in patients with relapsed or refractory (R/R) chronic lymphocytic leukemia (CLL), including undetectable minimal residual disease (uMRD). We retrospectively reviewed 62 patients with CLL treated with venetoclax to investigate the performance of peripheral blood (PB) compared with bone marrow (BM) assessment of MRD; the kinetics, clinicopathological associations, and longer-term outcomes of uMRD attainment and recrudescence; and the ability of venetoclax dose escalation to deepen responses. Among 16 patients who achieved PB uMRD and had contemporaneous BM assessments, 13 (81%) had confirmed BM uMRD, and patients with PB uMRD had outcomes at least as favorable as those with BM uMRD for time to progression, overall survival, and MRD recrudescence. Excluding 2 patients lacking earlier assessment, the median time to PB uMRD was 18 (range, 5-26) months, with 90% of instances achieved by 24 months. There was no new PB uMRD attainment after 24 months without treatment intensification. The dominant association with earlier attainment of uMRD was concurrent rituximab (P = .012). Complex karyotype was associated with inferior uMRD attainment after 12 months of therapy (P = .015), and patients attaining uMRD whose disease harbored TP53 abnormalities demonstrated a trend toward earlier recrudescence (P = .089). Of patients who received venetoclax dose escalations, 4 (27%) of 15 achieved improvements in response. For patients with R/R CLL receiving venetoclax, PB uMRD commonly correlates with BM uMRD and is associated with a comparable longer-term prognosis. Concurrent rituximab augments uMRD attainment, but dose escalation and further treatment beyond 24 months infrequently deepen responses.
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