Fixed-Duration First-Line Therapy for Chronic Lymphocytic Leukemia (CLL)/ Small Lymphocytic Lymphoma (SLL) in Canada: A Canadian Expert Clinical Framework

Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is an indolent B cell malignancy that may present with lymphocytosis, lymphadenopathy, splenomegaly, cytopenias, and/or immune complications.1,2 In 2023, 2,030 people in Canada (excluding Nova Scotia) were diagnosed with CLL, resulting in an incidence rate of 5.2 per 100,000 population.3 The CLL prevalence was projected to increase from 15,512 in 2020 to 19,517 in 2025, driven by rising incidence and longer survival from treatment improvements.4 The treatment landscape for CLL/SLL has evolved substantially with the introduction of multiple targeted therapies that differ in treatment duration, toxicity profile, and logistical complexity. This article discusses the current first-line treatment of CLL/SLL in Canada, focusing on fixed-duration (FD) treatment options that combine venetoclax with obinutuzumab, acalabrutinib, or ibrutinib, and discusses their implications for individualized treatment selection, therapeutic sequencing, and real-world implementation.