Adding Anti-CD20 Monoclonal Antibody to BTKi Therapy Superior to BTKi Alone in Patients With CLL

Adding anti-CD20 monoclonal antibodies (mAb) to Bruton tyrosine kinase inhibitor (BTKi) therapy in untreated or relapsed/refractory patients with chronic lymphocytic leukemia (CLL) offers significantly superior efficacy compared with BTKi monotherapy, according to a meta-analysis published online in Scientific Reports.

The systematic review and meta-analysis included 4 randomized controlled trials comparing outcomes with combined anti-CD20 mAb and BTKi therapy versus BTKi monotherapy in a total 1056 patients with CLL.

The addition of anti-CD20 mAb to BTKi significantly improved progression-free survival compared with BTKi monotherapy (0.70 hazard ratio), according to the study. However, the overall survival advantage was not statistically significant (0.72 hazard ratio).

The analysis also showed that combined anti-CD20 mAb and BTKi therapy was associated with a statistically improved complete response rate (2.03 relative risk) and undetectable minimal residual disease rate (6.43 relative risk). 

The risk of grade 3 or higher adverse events was comparable between patient groups. Aside from infusion-related reactions associated with anti-CD20 antibodies and a slightly increased risk of grade 3 or higher neutropenia and secondary primary malignancies with combination therapy, the safety profile of BTKi was largely unchanged with added anti-CD20 mAb.

“Conducting further randomized studies to confirm our results and determine the optimal therapy for managing patients with CLL is essential,” researchers advised.

Reference: 
Nguyen TT, Nhu NT, Tran VK, et al. Efficacy and safety of add-on anti-CD20 monoclonal antibody to Bruton tyrosine kinase inhibitor treatment for chronic lymphocytic leukemia: a meta-analysis. Sci Rep. 2023;13(1):9775. doi:10.1038/s41598-023-36279-x