Background: Chronic lymphocytic leukaemia (CLL) is the most common leukaemia among adults in Western regions, while India reports comparatively lower incidence rates. Bruton’s tyrosine kinase (BTK) inhibitors, particularly ibrutinib and acalabrutinib, have reshaped CLL therapy by blocking B-cell receptor signalling pathways essential for malignant B-cell survival. Objective: Given the increasing use of BTK inhibitors in routine practice and the limited real-world Indian data, this study evaluates the clinico-safety profile of BTK inhibitors and identifies predictors of response and progression in a pragmatic clinical setting. Materials and methods: This was a single-centre ambispective observational study conducted from June 2021 to June 2024 in patients diagnosed with CLL aged 18-70 years. The patients received ibrutinib (420 mg once daily) or acalabrutinib as per availability and physician decision. Results: Among the 93 patients included, most were male and younger than typical Western CLL cohorts. Hematologic recovery rates were high, with normalisation of haemoglobin, platelet count, and leukocyte count seen in the majority within four to seven months of therapy. The overall median progression-free survival (PFS) was 14 months. Conclusion: BTK inhibitors have significantly improved therapeutic outcomes in CLL. Both ibrutinib and acalabrutinib demonstrated meaningful hematologic responses and prolonged disease control. Acalabrutinib showed superior tolerability and better treatment adherence. Expanding access to genomic testing and improving drug availability will be essential to optimise CLL care in India.
Pradhan et al. (Tue,) studied this question.
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