'The HemOnc Pulse' Live Part One: The Question of MRD in CLL Therapy

Part one of this episode explores questions in measurable residual disease (MRD) and chronic lymphocytic leukemia (CLL) with Mazyar Shadman, MD, MPH, of Fred Hutchinson Cancer Center; Meghan Thompson, MD, of Memorial Sloan Kettering Cancer Center; and Alan Skarbnik, MD, of Novant Health.

“The HemOnc Pulse” was live for the first time in Chicago, Illinois, on May 3-4 and featured host Chadi Nabhan, MD, MBA, FACP, moderating panels of academic and clinical experts who delved into unanswered questions in various hematologic malignancies.

Following Dr. Shadman’s presentation on what he felt are the unanswered questions in CLL treatment, Dr. Thompson offered her own questions in the field.

“I think one overarching question in CLL, which is a very heterogeneous disease—with a third of patients never needing treatment and then double refractory patients—is patient selection for all of these different treatment options we have now,” she noted. “Especially in the discussion of pure [autologous transplantation] versus [chimeric antigen receptor T-cell therapy] in the refractory setting, but I think it’s coming into play in the upfront setting when we have doublet or triplet combinations.”

The topic of MRD as a prognostic marker frequently entered the various panel discussions. In this panel, Dr. Nabhan asked Dr. Skarbnik whether MRD is being used to guide time-limited therapies in patients with CLL.

“The way CLL14 was done was one year of treatment, regardless of what MRD status the patient had at the end of it; however, data from CLL14 and MURANO on time-limited therapies with venetoclax-based treatment showed that patients who achieve MRD have the potential for a longer treatment-free interval,” Dr. Skarbnik stated.

Dr. Shadman spoke further on how trials have investigated MRD in the treatment of CLL, asking, “Is MRD an indicator of a difficult disease to treat or is it your target to get rid of?”

“If you’re thinking of MRD-guided therapy versus not, the right study to do is to randomize patients to an MRD-guided therapy or fixed-duration [therapy] and not act on the MRD status at the end of treatment; in most of the studies we’re looking at, if you’re negative, you stop, and if you’re positive, you rerandomize or continue,” Dr. Shadman said.