The Shifting Sands of Blood Cancer Treatment: What’s Next for Myeloma and CLL?
The landscape of treating blood cancers like multiple myeloma (MM) and chronic lymphocytic leukemia (CLL) is undergoing a rapid transformation. New targeted therapies are moving beyond the academic research hospital and into community oncology practices, offering hope to more patients. But with this progress comes a need to understand how these drugs perform in ‘real-world’ settings – and whether current treatment strategies are truly sustainable.
Bispecific Antibodies: A Rapid Rise, But Who Benefits Most?
Bispecific antibodies, a relatively new class of drugs for relapsed or refractory multiple myeloma, are seeing remarkably quick adoption. Recent data from The US Oncology Network, presented at the American Society of Hematology (ASH) annual meeting, showed that in 2022, only 5% of eligible patients received a bispecific antibody. By mid-2025, that number jumped to 73%. This is encouraging, demonstrating access is improving.
However, the data also revealed a crucial nuance: patients receiving these therapies in community settings tend to be older and have slightly lower performance status compared to those enrolled in clinical trials. This highlights a critical point – real-world patients often present with more complex health profiles. “We’re seeing patients who might not have been included in the initial trials benefiting from these therapies,” explains Dr. Ira Zackon of Ontada. “But it also means we need to be mindful of potential challenges related to age and overall health when prescribing.”
Pro Tip: When discussing treatment options with your oncologist, be sure to openly share your complete medical history and any concerns you have about potential side effects, especially if you have pre-existing conditions.
BTK Inhibitors in CLL: The Challenge of Long-Term Use
Chronic lymphocytic leukemia (CLL) treatment has been revolutionized by Bruton tyrosine kinase (BTK) inhibitors like ibrutinib, acalabrutinib, and zanubrutinib. These drugs have shown impressive efficacy, but a recent study (CLL17) revealed a concerning trend: discontinuation rates are significantly higher in real-world practice than observed in clinical trials. Nearly two-thirds of patients discontinued treatment within the study period, primarily due to adverse effects.
While second-generation BTK inhibitors (acalabrutinib and zanubrutinib) were designed to have a better safety profile, the study found discontinuation rates remained substantial – around 40-50%. This raises a fundamental question: is indefinite treatment with these drugs realistic for many patients? The answer appears to be increasingly, “no.”
Did you know? The CLL17 trial is a landmark study comparing continuous BTK inhibitor therapy with time-limited approaches, offering valuable insights into the optimal treatment duration for CLL.
The Rise of Time-Limited Therapy and Combination Approaches
The high discontinuation rates with continuous BTK inhibitor therapy are fueling a shift towards time-limited treatment strategies. Combinations like venetoclax (a BCL-2 inhibitor) plus obinutuzumab (an anti-CD20 monoclonal antibody) are gaining traction. These approaches offer the potential for treatment-free intervals, improving quality of life and potentially reducing long-term costs.
“There’s a strong rationale for time-limited approaches,” says Dr. Zackon. “Patients are on therapy for a shorter duration, potentially achieving a treatment-free remission. This also addresses the financial burden of expensive, continuous therapies.”
Furthermore, the role of minimal residual disease (MRD) testing is becoming increasingly important. MRD assessment measures the amount of cancer remaining after treatment. If a patient achieves a deep MRD-negative response, it may be possible to safely stop therapy, although this is still an area of active research.
Personalized Medicine: Tailoring Treatment to the Individual
The future of blood cancer treatment lies in personalized medicine. Understanding the unique characteristics of each patient – age, performance status, comorbidities, genetic mutations – will be crucial for selecting the most appropriate therapy. The subtle differences in side effect profiles between BTK inhibitors, for example, allow oncologists to tailor treatment based on a patient’s individual risk factors.
For instance, patients with pre-existing cardiovascular disease might benefit from zanubrutinib, which has shown a slightly lower risk of heart-related side effects compared to ibrutinib. Similarly, careful consideration of a patient’s overall health and support system is essential when initiating bispecific antibody therapy, which requires close monitoring and logistical support.
Looking Ahead: What’s on the Horizon?
Several exciting developments are poised to further transform blood cancer treatment:
- New Drug Targets: Research is focused on identifying novel drug targets beyond BTK and BCL-2, offering the potential for even more effective therapies.
- CAR-T Cell Therapy: Chimeric antigen receptor (CAR) T-cell therapy, a type of immunotherapy, is showing promise in heavily pre-treated patients with MM and CLL.
- Improved MRD Assessment: More sensitive and standardized MRD assays will help guide treatment decisions and predict long-term outcomes.
- Digital Health Integration: Remote monitoring and telehealth technologies will play an increasingly important role in managing side effects and improving patient adherence.
Frequently Asked Questions (FAQ)
What are bispecific antibodies?
Bispecific antibodies are a type of immunotherapy that targets two different proteins simultaneously, helping the immune system recognize and destroy cancer cells.
What is MRD testing?
Minimal residual disease (MRD) testing measures the amount of cancer remaining after treatment. It can help predict the risk of relapse and guide treatment decisions.
Are BTK inhibitors right for everyone with CLL?
BTK inhibitors are highly effective for many patients with CLL, but they are not without side effects. Your oncologist will carefully evaluate your individual risk factors and benefits before recommending treatment.
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Take Action: Have an open and honest conversation with your oncologist about your treatment options and any concerns you may have. Don’t hesitate to ask questions and advocate for your own health. Share this article with others who may benefit from this information. Subscribe to our newsletter for the latest updates on blood cancer research and treatment.
