Onkológia 3/2025
A new era in the treatment of chronic lymphocytic leukemia: venetoclax as a tool for modern therapy – a retrospective group from Slovakia
Introduction: Chronic lymphocytic leukemia (CLL) has seen a paradigm shift in recent years with the advent of targeted therapies. Venetoclax, an oral BCL-2 inhibitor, has become a cornerstone of modern CLL treatment due to its ability to induce apoptosis independently of TP53 function. Its efficacy has been demonstrated across a broad spectrum of patients, including those with relapsed or refractory disease and high-risk genetic features. Patients and methods: This retrospective study analyzed 68 patients with CLL treated with venetoclax-based regimens at the Clinic of Hematology and Transfusiology in Bratislava between 2019 and 2024. Patients were categorized by treatment regimen: VO (venetoclax + obinutuzumab), VR (venetoclax + rituximab), V (venetoclax monotherapy), and VI (venetoclax + ibrutinib). Key endpoints included overall response rate (ORR), progression-free survival (PFS), overall survival (OS), and incidence of adverse events. Results: The VO regimen achieved a 100% ORR, with all patients attaining complete remission. The VR group showed a 90% ORR and a 4-year PFS of 59%. Venetoclax monotherapy yielded an ORR of 85%, a 5-year PFS of 42%, and an OS of 60%. Hematologic toxicities were the most common adverse events, particularly in the VO group. The overall safety profile was consistent with findings from clinical trials. Conclusion: Venetoclax-based regimens represent an effective and well-tolerated treatment option for CLL, even outside the framework of clinical trials. Fixed-duration therapies allow for deep remissions and improved quality of life. Our findings support the broader implementation of venetoclax in standard clinical practice and highlight the need for further research, particularly in the context of monotherapy. This study represents the first large-scale analysis of real-world clinical data from Slovakia, offering important insights into the efficacy and safety of venetoclax across different treatment regimens. These results may serve as a valuable foundation for the design and implementation of future prospective randomized trials, aimed at optimizing treatment strategies and advancing personalized care for patients with CLL.
Keywords: chronic lymphocytic leukemia, venetoclax, targeted therapy, fixed-duration regimen, retrospective analysis
