Strategy for selecting first-line CLL treatment
| TP53 status (del(17p)/TP53 mutation) . | Age/fitness . | IGHV MS . | First-line treatment (in order of authors’ preference) . |
|---|---|---|---|
| TP53 deleted and/or mutated | All | Either | (1) BTKi ± OBIN (continuous), (2) VEN + OBIN (fixed duration), no CIT |
| TP53 intact | Younger/fit | Mutated | (1) FCR (fixed duration), (2) VEN + OBIN (fixed duration), (3) BTKi ± OBIN (continuous) |
| Unmutated | (1) VEN + OBIN (fixed-duration), (2) BTKi ± OBIN (continuous) | ||
| Older/unfit | Mutated | (1) VEN + OBIN (fixed duration), (2) BTKi ± OBIN (continuous) | |
| Unmutated | (1) BTKi ± OBIN (continuous), (2) VEN + OBIN (fixed-duration) |
| TP53 status (del(17p)/TP53 mutation) . | Age/fitness . | IGHV MS . | First-line treatment (in order of authors’ preference) . |
|---|---|---|---|
| TP53 deleted and/or mutated | All | Either | (1) BTKi ± OBIN (continuous), (2) VEN + OBIN (fixed duration), no CIT |
| TP53 intact | Younger/fit | Mutated | (1) FCR (fixed duration), (2) VEN + OBIN (fixed duration), (3) BTKi ± OBIN (continuous) |
| Unmutated | (1) VEN + OBIN (fixed-duration), (2) BTKi ± OBIN (continuous) | ||
| Older/unfit | Mutated | (1) VEN + OBIN (fixed duration), (2) BTKi ± OBIN (continuous) | |
| Unmutated | (1) BTKi ± OBIN (continuous), (2) VEN + OBIN (fixed-duration) |
FCR, fludarabine, cyclophosphamide, and rituximab; MS, mutation status; OBIN, obinutuzumab.