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Patient Preferences for Fixed vs Continuous Therapies in CLL

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Medically reviewed by Dr. Brian Koffman

The Bottom Line:

The greatest patient preference was for therapies that offered a 90% progression-free survival (PFS) at two years over those who offered a 70% PFS.

Given equal efficacy, patients with CLL prefer fixed-duration over treat-to-progression therapies.

Who Performed the Research and Where Was it Presented:

Dr. Brian Koffman from the CLL Society and colleagues presented the results at the American Society for Hematology (ASH) Annual Meeting 2023.


Targeted therapies have revolutionized the treatment of chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). Currently, two main drug classes are used for treating CLL /SLL. The first is the Bruton tyrosine kinase (BTK) inhibitors (ibrutinib, acalabrutinib, zanubrutinib, pirtobrutinib), which are taken continuously until disease progression or intolerance. The second is the BCL2 inhibitors (venetoclax), usually taken for a fixed duration with an anti-CD20 antibody (rituximab, obinutuzumab). Both are very effective treatments, and this study looked at which type of therapy patients preferred.

Methods and Participants:

This study consisted of two parts. The first part was qualitative, in-depth interviews with patients to identify factors that are important to patients when considering treatments. The second part was a discrete-choice experiment online survey, where patients were asked to choose between two hypothetical treatments, which varied by different attributes such as treatment duration or risk of atrial fibrillation (abnormal heart rhythm).


  • Qualitative interviews were conducted with 20 patients with CLL, and 70% received treatment for CLL.
  • Half of the patients reported that treatment duration was significant in their treatment decision, and fixed duration was preferred over treat-to-progression if efficacy was the same.
  • For the quantitative survey, 229 patients with CLL participated, and 66% had received treatment for CLL.
  • The highest preference when patients were forced to make a choice was for 90% PFS at two years, confirmed by the MRD test, followed by a statistically lower preference for 90% PFS at two years. Both of these choices were far preferred over a 70% PFS at two years with or without the MRD test, though the MRD test was statistically preferred at the 70% level, too,
  • Most participants preferred a fixed-duration treatment of 6 or 12 months over treat-to-progression, but there was no preference for 6 or 12 months.
  • Oral therapies were preferred over IV, but it was unimportant if the oral dose was once or twice daily.
  • Patients were willing to put up with the increased risk of side effects (e.g., tumor lysis syndrome, atrial fibrillation (abnormal heart rhythm), and fatigue) to have a fixed-duration treatment.
  • Some reasons patients preferred fixed-duration treatment included easier budgeting, the convenience of getting a break from treatment and its side effects, feeling more in control, and not having to travel for appointments.
  • Some of the potential drawbacks of fixed-duration treatment included the potential for worse side effects while on treatment and worries that their cancer might spread if they are not taking medication.
  • A small group of patients preferred continuous treat-to-progression therapy because they felt that they were doing something and were comforted in knowing they were treating their cancer.
  • Some potential drawbacks of treat-to-progression therapies included worries that the medicine would stop working over time, cost of treatment, and inconvenience (always having to take medicine, get refills, go to appointments, and deal with side effects).


The patient’s primary concern is how well the therapy works. Given equal efficacy, patients prefer fixed-duration over treat-to-progression therapies. We have many good treatments available now for CLL, so it is really important for patients to voice their treatment preferences to their doctors. Your opinion matters, and shared decision-making is key to finding a treatment plan that works for you.

Links and Resources:

Watch the interview on the abstract here:

Patient Preferences for Fixed vs. Continuous Therapies in CLL – Dr .Brian Koffman ASH 2023

You can read the actual ASH abstract here: Patient Preferences for Fixed Versus Treat-to-Progression Therapies in Chronic Lymphocytic Leukemia.

Take care of yourself first.

Ann Liu, PhD