{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:44:27Z","timestamp":1783608267999,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hematology Reports"],"abstract":"<jats:p>Chronic lymphocytic leukemia (CLL), is a hematologic malignancy characterized by the uncontrolled proliferation of mature B lymphocytes. CLL is the most prevalent leukemia in Western countries. Its presentation can range from asymptomatic with the incidental finding of absolute lymphocytosis on a routine blood test, to symptomatic disease requiring immediate intervention. Prognosis of the disease is defined by the presence or absence of specific mutations such as TP53, chromosomal abnormalities such as del(17p), a type of IGHV mutational status, and elevation of B2M and LDH. Treatment of CLL in the United States and Europe has evolved over the recent years thanks to the development of targeted therapies. The standard of care has shifted from traditional chemoimmunotherapy approaches to targeted therapies including Bruton tyrosine kinase inhibitors (BTKis) and BCL2 inhibitors, administered either as monotherapy or in combination with CD20 monoclonal antibodies. Several clinical trials have also recently evaluated combinations of BTKi and venetoclax and showed the combination to be well tolerated and able to induce deep remissions. Targeted therapies have a good safety profile overall; however, they also have unique toxicities that are important to recognize. Diarrhea, fatigue, arthralgia, infections, cytopenias, bleeding, and cardiovascular toxicities (including atrial fibrillation, ventricular arrhythmias, and hypertension) are the adverse events (AEs) commonly associated with BTKis. Initiation of therapy with venetoclax requires close monitoring because of the risk for tumor lysis syndrome associated with this agent, particularly in patients with a high disease burden. Development of newer target therapies is ongoing and the therapeutic landscape in CLL is expanding rapidly.<\/jats:p>","DOI":"10.3390\/hematolrep15030047","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T09:32:35Z","timestamp":1690882355000},"page":"454-464","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["How I Manage Chronic Lymphocytic Leukemia"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5149-8618","authenticated-orcid":false,"given":"Patrice","family":"Nasnas","sequence":"first","affiliation":[{"name":"Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9104-5436","authenticated-orcid":false,"given":"Claudio","family":"Cerchione","sequence":"additional","affiliation":[{"name":"Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1947-1032","authenticated-orcid":false,"given":"Gerardo","family":"Musuraca","sequence":"additional","affiliation":[{"name":"Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-4210","authenticated-orcid":false,"given":"Giovanni","family":"Martinelli","sequence":"additional","affiliation":[{"name":"Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Ferrajoli","sequence":"additional","affiliation":[{"name":"Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,1]]},"reference":[{"key":"ref_1","unstructured":"(2022, October 09). Chronic Lymphocytic Leukemia\u2014Cancer Stat Facts, Available online: https:\/\/seer.cancer.gov\/statfacts\/html\/clyl.html."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e168","DOI":"10.1016\/S2352-3026(19)30253-4","article-title":"Tumour Lysis Syndrome in Patients with Chronic Lymphocytic Leukaemia Treated with BCL-2 Inhibitors: Risk Factors, Prophylaxis, and Treatment Recommendations","volume":"7","author":"Tambaro","year":"2020","journal-title":"Lancet Haematol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1002\/ajh.26367","article-title":"Chronic Lymphocytic Leukemia: 2022 Update on Diagnostic and Therapeutic Procedures","volume":"96","author":"Hallek","year":"2021","journal-title":"Am. J. Hematol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1038\/s41375-019-0602-x","article-title":"Long-Term Efficacy and Safety of First-Line Ibrutinib Treatment for Patients with CLL\/SLL: 5 Years of Follow-up from the Phase 3 RESONATE-2 Study","volume":"34","author":"Burger","year":"2019","journal-title":"Leukemia"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1056\/NEJMoa2114110","article-title":"Mechanisms of Resistance to Noncovalent Bruton\u2019s Tyrosine Kinase Inhibitors","volume":"386","author":"Wang","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_6","unstructured":"(2022, October 15). NCCN Clinical Practice Guidelines in Oncology Version 1. Available online: https:\/\/www.nccn.org\/guidelines\/guidelines-detail?category=1&id=1478."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/j.1365-2257.1982.tb00083.x","article-title":"Serum Beta-2 Microglobulin in Chronic Lymphocytic Leukaemia","volume":"4","author":"Montserrat","year":"1982","journal-title":"Clin. Lab. Haematol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.3109\/10428199609054782","article-title":"Serum \u03b22-Microglobulin and Serum Thymidine Kinase Are Independent Predictors of Progression-Free Survival in Chronic Lymphocytic Leukemia and Immunocytoma","volume":"22","author":"Hallek","year":"1996","journal-title":"Leuk. Lymphoma"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Autore, F., Strati, P., Innocenti, I., Corrente, F., Trentin, L., Cortelezzi, A., Visco, C., Coscia, M., Cuneo, A., and Gozzetti, A. (2019). Elevated Lactate Dehydrogenase Has Prognostic Relevance in Treatment-Na\u00efve Patients Affected by Chronic Lymphocytic Leukemia with Trisomy 12. Cancers, 11.","DOI":"10.3390\/cancers11070896"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3440","DOI":"10.1182\/bloodadvances.2021006434","article-title":"Up to 8-Year Follow-up from RESONATE-2: First-Line Ibrutinib Treatment for Patients with Chronic Lymphocytic Leukemia","volume":"6","author":"Barr","year":"2022","journal-title":"Blood Adv."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1182\/blood-2017-09-806398","article-title":"IwCLL Guidelines for Diagnosis, Indications for Treatment, Response Assessment, and Supportive Management of CLL","volume":"131","author":"Hallek","year":"2018","journal-title":"Blood"},{"key":"ref_12","unstructured":"(2022, November 05). Early Intervention in Asymptomatic Chronic Lymphocytic Leukemia\u2014Hematology & Oncology. Available online: https:\/\/www.hematologyandoncology.net\/archives\/february-2021\/early-intervention-in-asymptomatic-chronic-lymphocytic-leukemia\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.annonc.2020.09.019","article-title":"Chronic Lymphocytic Leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"32","author":"Eichhorst","year":"2021","journal-title":"Ann. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1080\/17474086.2022.2074393","article-title":"BTK inhibitor selection for chronic lymphocytic leukemia: Which drug for which patient?","volume":"15","author":"Desikan","year":"2022","journal-title":"Expert Rev. Hematol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Hus, I., Pu\u0142a, B., and Robak, T. (2022). PI3K inhibitors for the treatment of chronic lymphocytic leukemia: Current status and future perspectives. Cancers, 14.","DOI":"10.3390\/cancers14061571"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1056\/NEJMc2005943","article-title":"Ibrutinib for chronic lymphocytic leukemia with tp53 alterations","volume":"383","author":"Ahn","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"204062072199055","DOI":"10.1177\/2040620721990553","article-title":"The role of acalabrutinib in adults with chronic lymphocytic leukemia","volume":"12","author":"Fakhri","year":"2021","journal-title":"Ther. Adv. Hematol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1002\/onco.13685","article-title":"Ema Review of acalabrutinib for the treatment of adult patients with chronic lymphocytic leukemia","volume":"26","author":"Delgado","year":"2021","journal-title":"Oncologist"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lewis, K.L., and Cheah, C.Y. (2021). Non-Covalent BTK Inhibitors-the New BTKids on the Block for B-Cell Malignancies. J. Pers. Med., 11.","DOI":"10.3390\/jpm11080764"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1056\/NEJMoa2211582","article-title":"Zanubrutinib or Ibrutinib in relapsed or refractory chronic lymphocytic leukemia","volume":"388","author":"Brown","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1016\/S1470-2045(20)30443-5","article-title":"Venetoclax plus obinutuzumab versus Chlorambucil Plus obinutuzumab for previously untreated chronic Lymphocytic Leukaemia (cll14): Follow-up results from a multicentre, open-label, randomised, phase 3 trial","volume":"21","author":"Zhang","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"3278","DOI":"10.1182\/blood.2021014488","article-title":"Fixed-Duration Ibrutinib plus Venetoclax for First-Line Treatment of CLL: Primary Analysis of the CAPTIVATE FD Cohort","volume":"139","author":"Tam","year":"2022","journal-title":"Blood"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kater, A.P., Owen, C., Moreno, C., Follows, G., Munir, T., Levin, M.-D., Benjamini, O., Janssens, A., Osterborg, A., and Robak, T. (2022). Fixed-duration ibrutinib-venetoclax in patients with chronic lymphocytic leukemia and Comorbidities. NEJM Evid., 1.","DOI":"10.1056\/EVIDoa2200006"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"400","DOI":"10.6004\/jadpro.2022.13.4.4","article-title":"Practical management of the Venetoclax-treated patient in chronic lymphocytic leukemia and acute myeloid leukemia","volume":"13","author":"Waggoner","year":"2022","journal-title":"J. Adv. Pract. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100930","DOI":"10.1016\/j.blre.2022.100930","article-title":"CLL Update 2022: A Continuing Evolution in Care","volume":"54","author":"Kay","year":"2022","journal-title":"Blood Rev."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1111\/bjh.16345","article-title":"Practical Management of Tumour Lysis Syndrome in Venetoclax-Treated Patients with Chronic Lymphocytic Leukaemia","volume":"188","author":"Gribben","year":"2019","journal-title":"Br. J. Haematol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/PPO.0000000000000530","article-title":"Integrating new therapies for chronic lymphocytic leukemia","volume":"27","author":"Burger","year":"2021","journal-title":"Cancer J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/S0140-6736(21)00235-X","article-title":"Pirtobrutinib Shows Evidence to Inaugurate a Third Generation of BTK Inhibitors","volume":"397","author":"Michot","year":"2021","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1182\/blood-2017-10-809020","article-title":"Noncovalent Inhibition of C481S Bruton Tyrosine Kinase by GDC-0853: A New Treatment Strategy for Ibrutinib-Resistant CLL","volume":"132","author":"Reiff","year":"2018","journal-title":"Blood"},{"key":"ref_30","unstructured":"(2022, November 11). NEJM Journal Watch: Summaries of and Commentary on Original Medical and Scientific Articles from Key Medical Journals. Available online: https:\/\/www.jwatch.org\/na53334\/2021\/05\/20\/third-generation-bruton-tyrosine-kinase-inhibitor."}],"container-title":["Hematology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2038-8330\/15\/3\/47\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:23:53Z","timestamp":1760127833000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2038-8330\/15\/3\/47"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,1]]},"references-count":30,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["hematolrep15030047"],"URL":"https:\/\/doi.org\/10.3390\/hematolrep15030047","relation":{},"ISSN":["2038-8330"],"issn-type":[{"value":"2038-8330","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,1]]}}}