An increasing absolute lymphocyte count (ALC) is a recognized component of progressive disease (PD) in chronic lymphocytic leukemia (CLL). In randomized phase 3 trials, ALC contributes to measures such as progression‑free survival. Historically, studies of chemoimmunotherapy indicated that PD defined solely by rising ALC (ALC PD) was associated with more favorable outcomes than other modalities of progression. The authors sought to evaluate the incidence and clinical impact of ALC-only progression in the modern treatment era for CLL/SLL.
The analysis was a retrospective review of consecutive patients with CLL or small lymphocytic lymphoma treated at the University of Washington/Fred Hutchinson Cancer Center. The evaluated time window was 2016 through 2025. A total of 339 patients met inclusion for this cohort review. The report provides aggregated counts and comparative outcomes by frontline therapy category in this single‑center experience.
Patients received one of three frontline therapy strategies:
These categories reflect common contemporary approaches: continuous targeted kinase inhibition, chemoimmunotherapy, and time‑limited BCL2 inhibitor–based regimens.
The study reported that the cumulative incidence of ALC PD differed by frontline regimen. Specifically, ALC PD occurred more commonly after BR than after BTKi or BCL2i (P = .021). The abstract does not provide absolute incidence percentages, time‑to‑event curves, or numbers of patients with ALC PD in each treatment subgroup in the excerpt provided; those details would be available only in the full text.
Across treatment groups, patients whose progression was defined solely by rising ALC had superior survival outcomes after progression compared with patients who experienced other forms of progression. The abstract reports the following:
These findings reiterate earlier observations from chemoimmunotherapy eras that ALC‑only progression is associated with more favorable post‑progression survival than other progression modalities, and they extend the observation into a cohort treated with modern regimens including targeted agents.
The abstract indicates that time to next treatment and additional outcome measures were evaluated. However, the provided source text is truncated at the point where those results would be summarized (the sentence begins "Time to next treatment o" and is incomplete). Consequently, specific values, statistical comparisons, and any subgroup analyses related to time to next treatment, subsequent therapies, response to second‑line treatments, or other secondary endpoints are not reported in the supplied excerpt.
In this single‑center retrospective cohort of 339 patients with CLL/SLL treated from 2016 to 2025, the cumulative incidence of ALC‑only progression was higher following bendamustine‑rituximab than after BTKi or BCL2i frontline therapy. Patients experiencing ALC PD had substantially longer overall survival from progression than those with other types of progression (median 116 vs 71 months; HR 3.15; 95% CI, 1.52–6.53), with 5‑year OS estimates of 83% versus 56%.
Limitations: the abstract is truncated and the full text is needed to review detailed methods, absolute incidence rates, time‑to‑event analyses, and other outcome metrics such as time to next treatment. For complete data and subgroup analyses, consult the full article (Blood Advances; doi: 10.1182/bloodadvances.2026020680).