EHA 2026 consensus guidelines covering the full management spectrum of chronic lymphocytic leukemia (CLL) and Richter transformation — from initial diagnosis and active surveillance through first-line and relapsed/refractory treatment decision-making, incorporating patient advocacy input for the first time.
Key updates include EMA-approved time-limited acalabrutinib + venetoclax ± obinutuzumab as a first-line option, and continuous pirtobrutinib for patients previously exposed to covalent BTK inhibitors in the relapsed/refractory setting; Richter transformation is now explicitly addressed within the guideline scope.
Consensus-based guideline rather than a primary study; evidence grading specifics and individual recommendation strengths are not detailed in the abstract.
Clinicians can now offer a time-limited, chemo-free doublet/triplet (acalabrutinib + venetoclax ± obinutuzumab) up front for CLL, and should consider pirtobrutinib for patients who progress on or are intolerant of covalent BTK inhibitors. Treatment decisions should integrate both disease-specific and patient-specific factors, including surveillance for Richter transformation.
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