Two Distinct Clinical Patterns of Ibrutinib-to-Venetoclax Transition in Relapsed Chronic Lymphocytic Leukemia Patients
Round 1
Reviewer 1 Report
congratulations,
this short case report deserves acceptation in present form.
Just a curiosity: do the authors know know the BCR IG clonotype after IGHV sequencing?
It could be useful to correlate the BCR IG clonotype to the therapy response.
Author Response
We thank the reviewer for the nice comments.
We agree with the reviewer that it would be interesting to know the BCR IG clonotype for clinical correlations. Unfortunately, we do not have this information.
Reviewer 2 Report
Dear Authors,
this is an interesting case-study. It would be definitely worth to collect more data and to present it with statistical analysis.
As for the current paper:
- Please consider professional language correction - numerous grammatical structures require some attention
- Please add the ZAP-70 and CD38 status for those patients
- Patient age - is at the time of diagnosis or at the time of ibru-ven transition?
Author Response
We thank the reviewer for the nice comments.
1) English language has been carefully revised
2) ZAP-70 and CD38 status have been added to the revised paper
3) Patient age is at the time of ibrutinib-to-venetoclax transition
Reviewer 3 Report
The transition from Ibrutinib to Venetoclax treatment in Ibrutinib-relapsing patients is the main focus of this work, where the authors test the efficacy of combined Ibrutinib-Venetoclax treatment during the Venetoclax transition scale-up in three patients. Their results demonstrate that, when leukemic cells are mutated in Btk and Plcg2, patients exhibit a huge response to Venetoclax starting from the period of combination therapy and ongoing. Conversely, in the absence of Btk and Plcg2 mutations Ibrutinib interruption after 14 days favours disease burden. The authors suggest that this might be due to the fact that, when disease progression is due to mechanisms different from Btk pathway mutations, Ibrutinib is still required to maintain the Btk axis under control.
This work is interesting and very well organized. I do not have comments.
I only found a typo in the supplementary references that I would highlight. The authors wrote: "...monoclonal B-cell lymphocytosis and ultr, et al. a-stable chronic lymphocytic leukemia ...". Please cut et al.
Author Response
We thank the reviewer for the nice comments.
We have edited the supplementary reference as suggested by the reviewer.
