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First-Line CLL Fixed-Duration — RACP Adult Medicine MCQ

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ModerateHaematologyFirst-Line CLL Fixed-DurationRACP Adult Medicine

A 55-year-old fit man with CLL (Rai stage II) requires treatment. FISH shows del(13q) only (favourable). IGHV is mutated. He has no comorbidities. eGFR is 90 mL/min/1.73m². He prefers time-limited treatment. What is the most appropriate first-line treatment?

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Correct answer: E — Venetoclax plus obinutuzumab

Fit patients with IGHV-mutated CLL and favourable FISH have the best prognosis. For patients preferring time-limited (fixed-duration) treatment, venetoclax plus obinutuzumab (12 months) is preferred. FCR remains an option for young fit patients with mutated IGHV (excellent long-term outcomes in CLL8/FLAIR), but targeted therapy is increasingly preferred first-line given superior PFS in randomised trials.

Reference: ALLG – 2024 – CLL; CLL14 Trial; iwCLL 2024