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Note: the green color indicates higer sucra values with a greater probability ofbeing the more effective (c) or the safer (d) treatment and the red color indicates lower sucra values with a lower probability of being the best (c) or the safest treatment. gl When we analyzed safety outcomes, reduced toxicity was associated with increased SUCRA values. 7 Molica S, Giannarelli D, Montserrat E. Comparison between Venetoclax-based and Bruton tyrosine kinase inhibitor-based therapy as upfront treatment of chronic lymphocytic leukemia (CLL): a systematic review and network meta-analysis. To the Editor, The current shift in the treatment paradigm from chemoimmunotherapy to targeted agent (TA) therapy has rapidly changed the therapeutic landscape of chronic lymphocytic leukemia (CLL).[1] Current European and US guidelines recommend continuous first-generation or second-generation Bruton tyrosine kinase inhibitors (BTKis) and time-limited venetoclax-based therapy in the setting of previously untreated or relapsed-refractory CLL.[[2]] However, the lack of head-to-head randomized clinical trials, especially in the upfront setting, limits the potential of guidelines to address questions related to the choice of TA. Of note, adverse events lead to lower adherence to therapy, compromising the chosen treatment's clinical efficacy and need to be considered in treatment selection.[19] This study has some limitations. [Extracted from the article]

In the non-inferiority designed ELEVATE RR study, which directly compared ibrutinib and acalabrutinib in R/R CLL patients, treatment discontinuations related to adverse events occurred less frequently in acalabrutinib-treated patients (15%) than in ibrutinib-treated patients (21%) [[19]]. More than twenty years ago, the tyrosine kinase inhibitor imatinib, used in the treatment of chronic-phase chronic myeloid leukemia (CML), heralded a new era of targeted oral treatments in hematology [[1]]. Current oncology practices should continue to develop standard procedures for patient education, the development, and sharing of treatment plans, and routine monitoring of patient adherence to oral antineoplastic therapies. We should also be mindful that good communication between healthcare professionals and patients is crucial to enable our CLL patients to obtain maximal benefit from therapy whilst toxicities are minimized [[21]]. [Extracted from the article]

Keywords: chronic lymphocytic leukaemia; chemotherapy; clinical trial; monoclonal antibody; minimal residual disease EN chronic lymphocytic leukaemia chemotherapy clinical trial monoclonal antibody minimal residual disease 646 650 5 07/29/21 20210801 NES 210801 Chemoimmunotherapy (CIT) comprising cytotoxics and anti-CD20 monoclonal antibodies (mab) has long been the therapeutic mainstay for chronic lymphocytic leukaemias (CLL). COSMIC, c hemotherapy plus o fatumumab at s tandard or m ega-dose i n c hronic lymphocytic leukaemia, a phase II randomised study. [Extracted from the article]

Serum IgG level between4-5 g/L was noted in 11 of 28 patients (39%), very low IgG (<4 g/L) in 8 of 28 patients (29%) and 2 patients had completely undetectable IgG <0.75 g/L (7%). Survival plots of CLL patients with (a) documented infections on ibrutinib therapy and (b) serum IgG level before start of ibrutinib therapy. Patient characteristics with CLL genetics, treatments received, immunoglobulin levels, infections and deaths on ibrutinib therapy. We report a retrospective analysis on 26 ibrutinib-treated relapsed/refractory CLL patients and 3 CLL patients who received ibrutinib as first line therapy from January 2016 to May 2020. [Extracted from the article]