Alternative treatment to front‑line treatment can be administered for patients with relapsed or refractory CLL:
A percentage of CLL patients respond to treatment, but then their response stops. This is known as relapse, or it is sometimes called a recurrence.
- In addition, the majority of patients who do respond to treatment for a period of time relapse eventually and require alternative treatment.
When patients relapse but have no symptoms, Active monitoring (similar to when they had no symptoms after diagnosis) is started.
For symptomatic relapse within three years of fixed-duration therapy and refractory CLL, the following alternative treatments are started:
- Venetoclax plus rituximab for 24 months
- Ibrutinib or acalabrutinib as continuous therapy
- PI3K inhibitor such as idelalisib in combination with rituximab
- Limited cycles of chemoimmunotherapy is only appropriate for patients without del(17p)or a P53 Repeated administration of chemotherapy is not recommended because of the increased toxicity rates and risk of secondary myeloid neoplasm.