ABSTRACT Introduction Novel targeted agents have transformed the treatment of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), including continuous BTK inhibitor (BTKi) therapy and time‐limited regimens such as venetoclax‐obinutuzumab (Ven‐O) and ibrutinib‐venetoclax (I + V). However, factors guiding first‐line treatment decisions in routine practice remain poorly defined. Objectives To describe real‐world first‐line treatment patterns and identify factors associated with therapy selection. Methods This retrospective, population‐based study included consecutive patients initiating first‐line therapy for CLL/SLL in 2024 in Alberta, Canada. Results Among 148 patients with median age 71 years, time‐limited targeted therapy was selected for 75 (51%), including Ven‐O ( n = 73) and I + V ( n = 2). Continuous BTKi therapy was used in 65 (44%), while chemotherapy‐based regimens were uncommon ( n = 8, 5%). Among 138 patients treated with either continuous BTKi or Ven‐O, BTKi use was significantly more frequent among those with del(17p)/ TP53 mutation (84% vs. 16%, p = 0.0002), age > 75 years (66% vs. 34%, p = 0.0051), and residence > 100 km from an obinutuzumab‐initiating cancer center (70% vs. 30%, p = 0.031). Conclusions Time‐limited and continuous targeted therapies are used with similar frequency for CLL/SLL, with selection shaped by age, TP53 aberrations, geography, and patient preferences. These findings highlight the importance of personalized care and the need to reduce access barriers to time‐limited strategies.
Tidswell et al. (Mon,) studied this question.
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