The 20th edition of the international workshop on Chronic Lymphocytic Leukaemia (iwCLL) in Boston showcased significant progress in the management of CLL. In this summary we highlight key findings and emerging insights from the conference.

  • Supportive care: infection still represent a significant threat for CLL patients, focusing on prevention remains crucial. Major role for vaccination and immunoglobulins replacement.
  • First line treatment: advances in first line CLL treatment have expanded options beyond chemoimmunotherapy. Continuous treatment with covalent BTK inhibitors (cBTKi) as well as fixed-duration treatment such as Obinutuzumab-Venetoclax are effective options for fit and unfit patients.
  • Minimal residual disease (MRD): MRD is a strong predictor of prolonged PFS and OS in CLL. However, the relevance of MRD kinetic and its connection to treatment response varies according to the scheme. New techniques considering also the nodal compartment are needed.
  • Relapse and emerging therapies: resistance mechanisms and emerging drugs to address double-refractory CLL patients have been explored. New BCL-2 inhibitors, non-covalent BTK inhibitors (ncBTKi) and BTK degraders are the most promising agents. CAR-T cell therapy and bispecific antibodies (BiTEs) also show an interesting preliminary activity in this setting.
  • Richter transformation (RT): RT is associated to a wide genetic heterogeneity and poor outcome. New treatments and particularly CAR-T and BiTEs seem promising in this setting.

(BELG J HEMATOL 2023;14(8):347–50)