In a patient who has been receiving 1L Ibrutinib for TP53+ CLL for years with complete hematologic response but detectable MRD, is there any role to switch to the novel BTKi agents given better PFS?

There are a couple of features to this question that need comment. First, the goal of therapy with a single-agent BTKi, regardless of ibrutinib, acalabrutinib, zanubrutinib, or pirtobrutinib, is NOT to achieve undetectable MRD. Very few patients will achieve this milestone due to the drug's MOA. BTK...

In general, I have not switched patients who are responding well to ibrutinib to a second-generation covalent BTK inhibitor due to the concern for the potential to develop adverse events with a new treatment. Additionally, the role of MRD here is limited as there is no data to suggest that uMRD is p...