So turning to treatment, what are the most important developments in the treatment-naive CLL?

Yeah.

So as Paolo Ghia mentioned, one of the reasons why we did this update was that we have now a new treatment option being approved, which is a combination of acalabrutinib plus venetoclax with or without obinutuzumab.

We had already in the ESMO guidelines the other time-limited options as venetoclax plus obinutuzumab or venetoclax included, but now having these additional options, in, in particular the triplet combination, where there is a lot of discussion ongoing considering the higher rates of infections with the triplet combination versus not, and these were all included now, uh, in the guidelines.

As Paolo Ghia mentioned, um, we are considering the different biological risk factors for stratification, and therefore patients with TP53 mutation, deletion 17p, and there is not so much change because we still in the first place recommend continuous treatment with BTK inhibitors.

But for the CLL with mutated and unmutated IGHV status, due to s- different options now of combinations with BTK inhibitors plus venetoclax, these are coming on the first place for CLL with unmutated IGHV status, and for CLL with mutated IGHV status in the first place remain with venetoclax plus obinutuzumab.

And then there are the other options also listed, but these would be the first preferences.

How does this guideline recommend to manage it?

Barbara Eichorst discusses findings from a CLL frail study evaluating continuous acalabrutinib in older and frail patients with CLL.

We did a trial in a patient population which is usually not addressed in CLL, which are patients above the age of 80 years or having a high FRET score according to their own judgment.

And we treated these patients with continuous treatment with acalabrotinib.

And what the studies show is that the response rate and the PFS rates are really high.

Very remarkable in this elderly patient population.

However, we do see that more than one-third of the patients are stopping the treatment within two years due to side effects.

Also showing how vulnerable this patient population is.

Please consult your local SMPC or its equivalent for further information.

[ on-hold music] Hello, my name is Barbara Eichhorst, and I'm from the University Hospital in Cologne in Germany.

And welcome to this program entitled Chronic Lymphocytic Leukemia Data-Driven Updates in First-Line and Relapsed/Refractory Disease.

So what we've got planned are several chapters that break down the treatment scene for CLL as well as for relapsed/refractory mantle cell lymphoma.

I will present the clinical updates for first-line treatment of CLL.

Then my colleague, Toby Ayra from the UK, will discuss advancements in relapsed/refractory CLL in second line and beyond.

Followed by Catherine Coombs from California, who will discuss the clinical perspective and practice implications across all different lines of treatment in CLL care.