Real-World Applicability of BTKi Use and Comparative Outcomes

Video content above is prompted by the following:

Bruton tyrosine kinase (BTK) inhibitors have become established therapies in real-world chronic lymphocytic leukemia (CLL) practice, with many clinicians preferring monotherapy approaches, particularly in community practice settings. The adoption of combination therapies varies between academic and community practices, with specialized lymphoma centers more likely to implement complex combination regimens based on detailed understanding of trial data and patient-specific factors. This variation highlights the importance of continuing medical education and knowledge dissemination to ensure optimal treatment selection across different practice environments.

Infection risk patterns differ between continuous and fixed-duration CLL therapies, with important implications for real-world treatment decisions. Continuous BTK inhibitor monotherapy generally results in lower infection rates and fewer treatment interruptions compared with fixed-duration combination regimens that include anti-CD20 antibodies. However, many recent combination therapy trials were conducted during the COVID-19 pandemic, complicating direct comparisons with prepandemic fixed-duration studies like CLL14, making it challenging to accurately assess relative infection risks between different approaches.

Real-world implementation of CLL therapies must account for the temporal context of clinical trial conduct and evolving practice patterns. The pandemic’s impact on infection reporting in clinical trials creates uncertainty when comparing safety profiles from different treatment eras. Despite these challenges, continuous BTK inhibitor therapy generally demonstrates lower discontinuation rates due to infections, supporting its role as a preferred approach for many CLL patients in routine clinical practice.