Maintenance therapy for chronic lymphocytic leukaemia

Area of Science:

• Hematology
• Oncology
• Clinical Trials

Background:

• Chronic lymphocytic leukemia (CLL) is an incurable lymphoproliferative disease requiring effective treatment strategies.
• Maintenance therapy is explored to prolong response duration in CLL patients achieving remission.
• The benefits and harms of various maintenance therapies for CLL remain uncertain.

Purpose of the Study:

• To assess the efficacy and safety of maintenance therapies in individuals with CLL.
• Included therapies: anti-CD20 monoclonal antibodies, immunomodulatory drugs, anti-CD52 monoclonal antibodies, Bruton tyrosine kinase inhibitors, and B-cell lymphoma-2 tyrosine kinase inhibitors.

Main Methods:

• Comprehensive literature search for randomized controlled trials (RCTs) across multiple databases.
• Included RCTs compared maintenance therapies against placebo/observation or head-to-head.
• Risk of bias and certainty of evidence (GRADE) assessed for outcomes like OS, PFS, and AEs.

Main Results:

• Eleven RCTs (2393 participants) were included; no trials on novel small molecular inhibitors were found.
• Anti-CD20 mAbs maintenance improved PFS (moderate-certainty) but increased grade 3/4 and all AEs (low-certainty).
• Immunomodulatory drug (lenalidomide) maintenance significantly increased PFS (moderate-certainty) and grade 3/4 AEs (low-certainty).

Conclusions:

• Moderate- to very low-certainty evidence suggests anti-CD20 mAbs and IMiD maintenance improve PFS in CLL but increase AEs.
• No significant differences in overall survival (OS) were observed between maintenance and control groups for these therapies.
• The effects of alemtuzumab maintenance are uncertain, with no studies found for other novel targeted therapies.