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Fixed-Duration versus Continuous Treatment for Chronic Lymphocytic Leukemia

CLL17 shows that fixed‑duration venetoclax–obinutuzumab or venetoclax–ibrutinib is noninferior to continuous ibrutinib upfront, with 3‑year PFS ≈80% across all arms. The big difference is depth of response, undetectable MRD was 73% with venetoclax–obinutuzumab, 47% with venetoclax–ibrutinib, and 0% with ibrutinib. Toxicities tracked with mechanism (more cytopenias/infusion reactions with ven‑obinutuzumab, more cardiac events with ibrutinib). Overall, this strongly supports time‑limited therapy as a frontline standard for many chronic lymphocytic leukemia (CLL) patients.

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BRUIN CLL-313: Randomized Phase III Trial of Pirtobrutinib Versus Bendamustine Plus Rituximab in Untreated Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

Pirtobrutinib demonstrated superiority over bendamustine rituximab in IRC assessed progression free survival (PFS) in treatment naïve CLL/SLL, with a 24 month PFS rate of 93.4% versus 70.7%. Overall survival trends favored pirtobrutinib, despite the study design allowing for crossover. Who would have thought this was coming????

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Acalabrutinib treatment for older (aged ≥80 years) and/or frail patients with CLL: primary end point analysis of the CLL-Frail trial Open Access

Acalabrutinib in patients aged ≥80 years demonstrated 12-month progression-free (PFS) and overall survival (OS) rates of 93.3% and 95.7%, respectively, after a median follow-up of 19 months. Adverse events were severe but rarely included major bleeding or atrial fibrillation. Patient-reported quality of life improved, including amerlioration of frailty.

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