TO THE EDITOR:

Ibrutinib is approved for all lines of therapy in patients with chronic lymphocytic leukemia (CLL) in the United States. Randomized studies have consistently demonstrated superior progression-free survival (PFS) in relapsed/refractory1,2  and treatment-naïve CLL patients treated with ibrutinib.3-5  Furthermore, single-agent ibrutinib improved overall survival (OS) in 2 phase 3 studies compared with ofatumumab in relapsed/refractory CLL (RESONATE) and with chlorambucil in treatment-naïve patients older than 65 years (RESONATE-2). In these studies, ibrutinib was dosed continuously at 420 mg once daily. A retrospective analysis of the RESONATE trial reported that mean ibrutinib dose intensity <95% was associated with inferior PFS but not OS. However, observation time of this study was limited to the first 9 months of therapy, when dose adherence is particularly important and early interruptions may indicate more advanced disease or concurrent health issues that interfere with effective delivery of...

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