At the 2025 American Society of Hematology (ASH) Annual Meeting, Callie Coombs, MD, UCI Health hematologist-oncologist, discussed emerging results from the BRUIN-CLL-314 trial evaluating a noncovalent BTK inhibitor compared with ibrutinib in patients with CLL.

While the study met its primary endpoint of noninferiority for overall response rate, early signals around progression-free survival and tolerability are shaping important clinical conversations. In particular, improved tolerability, including a lower risk of atrial fibrillation, may make noncovalent BTK inhibition an appealing option for select older patients who are likely to receive a single line of therapy.

At the same time, Coombs emphasizes the need for caution in younger patients, noting that longer follow-up is necessary to better understand the durability of response and the potential implications for resistance across subsequent lines of therapy.