NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

44 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 Treatment for CLL with del(17p) or TP53 mutation Guide 9 lists first-time treatment options for CLL that is missing parts of chromosome 17 or has a TP53 mutation. A clinical trial is advised. If you can’t join a clinical trial, ibrutinib is the standard of care. Other options include HDMP with rituximab, obinutuzumab, and alemtuzumab with or without rituximab. If first-time treatment works, treatment may continue with a drug like ibrutinib or idelalisib until the disease progresses. If the disease gets worse, options include a clinical trial, possible allogeneic SCT if you are healthy enough, or other drugs listed in Guide 9. Another phase of treatment is called maintenance. This phase starts after you are finished first-line treatment. Maintenance therapy is given to keep up (maintain) the good results of prior treatments. The goal is to prevent a relapse after first-line therapy and in some cases, after second-line therapy for CLL with del(17p) or TP53 mutation. After first-line treatment, your doctor may consider maintenance therapy with lenalidomide if you are at high risk for the disease to relapse (come back). Guide 10 lists treatment options for if the CLL responds but comes back (relapsed), or if the first treatment doesn’t work (refractory). Join a clinical trial if possible. If you are healthy enough your doctor may also consider an allogeneic SCT. He or she may assess the cancer to see if there is a change in the cells such as Richter’s transformation or CLL with progression. 4 Treatment guide CLL with del(17p) or TP53 mutation Guide 9. First-time treatments including purine analogs Treatment options (best options listed first) • Ibrutinib • HDMP + rituximab • Obinutuzumab • Alemtuzumab ± rituximab Guide 10. Treatments if prior treatment fails Treatment options (best options listed first) • Ibrutinib • Venetoclax ± rituximab • Idelalisib + rituximab • Idelalisib • HDMP + rituximab • Lenalidomide ± rituximab • Alemtuzumab ± rituximab • Ofatumumab