[Recent advances and future perspectives in the treatment of chronic lymphocytic leukemia]

The treatment of chronic lymphocytic leukemia (CLL) has rapidly evolved from traditional chemoimmunotherapy to molecular targeted therapies. Current recommended first-line treatment options include covalent BTK inhibitor (cBTKi: ibrutinib, acalabrutinib±obinutuzumab, and zanubrutinib)-based regimens and BCL2 inhibitor (BCL2i: venetoclax)-containing regimens (venetoclax+obinutuzumab and venetoclax+ibrutinib). The former approach relies on continuous treatment with cBTKi for long-term disease control, and the latter is a time-limited approach using BCL2i aiming for long-term treatment-free remission. Molecular and genetic features of CLL, performance status, comorbidities, social support systems, and patient preference are considered in treatment selection for CLL. The non-covalent BTK inhibitor pirtobrutinib has recently been approved for patients with relapsed or refractory CLL who have previously been treated with a cBTKi. The durability of responses to initial and subsequent treatment of CLL has greatly extended life expectancy, and newer agents including BTK degraders, next-generation BCL2 inhibitors, novel antibodies (antibodies against BAFF, CD19, or ROR1, along with CD3×CD20 bispecific antibodies), and chimeric antigen receptor T-cell therapies should further improve quality of life for all patients.