Contemporary Fixed-Duration Treatment Options in the First-Line Setting of Chronic Lymphocytic Leukemia: Perspectives from a Publicly Funded Healthcare System
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThis is an atypical paper in the form of an interview with five Canadian experts in the field. However, the challenge of choosing optimal treatment in 1st line CLL is a very hot topic. Therefore, this article would be interesting to clinicians worldwide. The references cited in the paper are appropriate and the data from the relevant studies are shown in the tables. Overall, the quality of the manuscript is very good, and my recommendation is to accept it in the current form.
A minor comment: Most of the sentences are long and complex, thus less concise. However, the whole paper is written in a journalist manner (as an opinion), not as a scientific paper and I would not insist on changing the style.
Author Response
The authors kindly thank the reviewer for their careful review and feedback on the manuscript. No changes have been made related to the comments provided.
Reviewer 2 Report
Comments and Suggestions for AuthorsThe manuscript provides a good and comprehensive overview of fixed-duration (FD) treatment options for first-line chronic lymphocytic leukemia (CLL) in the Canadian healthcare context. The work is well written, informative, and relevant given the evolving treatment landscape of CLL. However, some parts would benefit from better clarity in interpretation, and attention to methodological transparency.
Major Revisions
- Conflict of Interest and Funding Transparency: While conflicts of interest are declared, the influence of pharmaceutical industry sponsorship (AstraZeneca) on the selection of discussion questions and interpretation of hematologists’ perspectives should be addressed more explicitly. Readers should be reassured about the independence of clinical opinions.
- Methodology: The methods section describes the use of a medical writer and structured questions but does not explain well how hematologists were selected (based on expertise, geography, or centers). More detail is reqired to establish representativeness and reduce selection bias.
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The manuscript strongly favors FD regimens. While this is consistent with evolving practice, the narrative risks underrepresenting the ongoing importance of continuous BTKi therapy. More balanced discussion of situations where continuous therapy may still be optimal (beyond TP53 aberrations) would strengthen the objectivity.
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The manuscript points out the access challenges but does not adequately address the broader implications of cost-effectiveness, funding delays, and real-world disparities across provinces. Expanding this section with supporting evidence (wait times, drug reimbursement variations) would enhance the paper’s relevance.
Minor Revisions
- Terminology Consistency: The manuscript alternates between “FD” and “fixed duration” with no consistency. Standardize throughout.
- References: Ensure uniform reference formatting (several citations are inconsistent in spacing, journal abbreviations, or style).
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsThe paper puts the focus on something that is not usually on scientific articles, that is availability and affordability of novel therapies. Although novel therapies and novel strategies are appearing, msny of them are not available out of clinical trials or in a public health system. Additionally, fixed duration therapies are novel approaches for CLL treatment and pros or cons of this strategy have to be carefully analyzed. The paper makes a simple but effective review of the available fixed-duration therapies for CLL, at present and those that will be available soon, and then presents some questions about the key facts and concerns about them. Overall, the discussion is interesting and clear, and can help other hematologists to take decisions on their own patients.
Although being funded by a pharmaceutical company with clear interest on CLL, I do not appreaciate bias towards that company on the discussion or conclusions.
To conclude, I appreciate the effort to write a paper from a different point of view and I admit it was worth reading.
Author Response
The authors kindly thank the reviewer for their careful review and feedback on the manuscript. No changes have been made related to the comments provided.
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsThank you for adressing my comments
