Prof Stilgenbauer (University of Ulm, Ulm, Germany) chairs an expert discussion for ecancertv on the latest data presented at ASH 2016 helping to shape the rapidly evolving CLL landscape.

He is joined by Dr Jones (Ohio State University, Columbus, USA), Prof Wendtner (Klinikum Schwabing, Munich, Germany) and Prof Coutre (Stanford University School of Medicine, Stanford, USA).

The panel first looked at presentations focused on Lenalidomide (LEN) in the maintenance setting, with results of the M1 trial of the German CLL study group showing LEN substantially prolonged PFS in high risk CLL patients as a maintenance option after chemoimmunotherapy.

Although positive results were seen, it was suggested that question marks remain over the clinical utility of this treatment option.

At ‘the forefront of chemo free treatments’ is ibrutinib, with follow-up data discussed from the Phase III RESONATE-2 trial, which led to the approval of ibrutinib as a first-line treatment for patients with CLL earlier in the year.

Following this, the panel discussed efficacy and safety results from the longest follow-up to date for ibrutinib treated CLL/SLL patients, showing durable responses through five years of treatment.

There were also positive results seen with Idelalisib in combination with Bendamustine and Rituximab in patients with Relapsed/Refractory CLL.

Following previous reports of improved PFS, data presented at this year’s ASH also showed OS improvement across risk categories.

Discussion then moved on to data looking at novel agents and combinations including venetoclax (VEN) monotherapy and in combination with obinutuzmab and ibrutinib.

The panel also touched on results from the Phase II CLL2-BIG trial of Bendamustine followed by GA101 and Ibrutinib followed by Ibrutinib and GA101 maintenance in CLL patients.

With the recent paradigm shifts in how CLL is treated, the introduction of novel agents and combinations seek to further ‘expand the CLL toolbox’.

With the immunotherapy ‘hype not over’ and the role of CAR T-cell therapies being further explored, advances in CLL are set to remain the pacemaker in haematology.

This programme has been supported by an unrestricted educational grant from Janssen Pharmaceuticals (A Johnson & Johnson Company).