Monitoring Response and Resistance to Treatment in Chronic Lymphocytic Leukemia.

Simple Summary: Novel targeted agents in chronic lymphocytic leukemia (CLL) are employed with different strategies. The evolution of response assessment criteria of the clinical application of measurable residual disease (MRD) analysis and the novel genetic and non-genetic mechanisms of resistance according to the novel treatment strategies within clinical trials are reviewed. Our view on how this knowledge can be applied to the current and future real-life management of CLL patients is discussed. The recent evolution in chronic lymphocytic leukemia (CLL) targeted therapies led to a progressive change in the way clinicians manage the goals of treatment and evaluate the response to treatment in respect to the paradigm of the chemoimmunotherapy era. Continuous therapies with BTK inhibitors achieve prolonged and sustained control of the disease. On the other hand, venetoclax and anti-CD20 monoclonal antibodies or, more recently, ibrutinib plus venetoclax combinations, given for a fixed duration, achieve undetectable measurable residual disease (uMRD) in the vast majority of patients. On these grounds, a time-limited MRD-driven strategy, a previously unexplored scenario in CLL, is being attempted. On the other side of the spectrum, novel genetic and non-genetic mechanisms of resistance to targeted treatments are emerging. Here we review the response assessment criteria, the evolution and clinical application of MRD analysis and the mechanisms of resistance according to the novel treatment strategies within clinical trials. The extent to which this novel evidence will translate in the real-life management of CLL patients remains an open issue to be addressed. [ABSTRACT FROM AUTHOR]

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