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In relapsed CLL, a time-limited venetoclax-rituximab course cut progression risk by more than 80% compared with bendamustine-rituximab and later improved survival.
MURANO randomised 389 patients with relapsed or refractory CLL to venetoclax for two years plus six months of rituximab, or six cycles of bendamustine-rituximab. The primary endpoint was investigator-assessed PFS. At 24 months PFS was 84.9% versus 36.3% (hazard ratio 0.17), with benefit across del(17p) and other high-risk subgroups. Rates of undetectable MRD were much higher with venetoclax-rituximab. With five years of follow-up the overall survival advantage held (about 82% versus 62%), and most patients who reached undetectable MRD at end of therapy stayed in remission for years off treatment.
MURANO made fixed-duration venetoclax the standard for relapsed CLL and showed that stopping therapy after a deep response is safe for most patients. It also established MRD at end of treatment as a practical guide to who is likely to stay in remission. Retreatment with venetoclax at relapse appears feasible.
Shares John F. Seymour, Bendamustine, Relapsed or refractory chronic lymphocytic leukaemia, AbbVie (incl. ImmunoGen, Capstan).
Shares del(17p) / TP53 aberration in CLL, BCL-2, AbbVie (incl. ImmunoGen, Capstan), CD20.
Shares CLL14: one year of venetoclax plus obinutuzumab instead of chemo-immunotherapy in older, less fit CLL patients, BCL-2, CD20, Venetoclax.
Shares CLL14: one year of venetoclax plus obinutuzumab instead of chemo-immunotherapy in older, less fit CLL patients, BCL-2, CD20, Venetoclax.
Shares CLL14: one year of venetoclax plus obinutuzumab instead of chemo-immunotherapy in older, less fit CLL patients, BCL-2, CD20, Venetoclax.
Shares del(17p) / TP53 aberration in CLL, Venetoclax, Rituximab, Chronic lymphocytic leukaemia.
Shares Relapsed or refractory chronic lymphocytic leukaemia, AbbVie (incl. ImmunoGen, Capstan), Venetoclax, Chronic lymphocytic leukaemia.
Shares del(17p) / TP53 aberration in CLL, BCL-2, CD20, Venetoclax.