74岁，男性，因乏力就诊被确诊为慢性淋巴细胞白血病（CLL）；血常规（CBC）示：WBC 18.8×10⁹/L、ALC 11.6×10⁹/L、HB 9.4g/dL、PLT 89×10⁹/L，体格检查发现颈部、锁骨上、腋下增大淋巴结，大者直径约4cm，脾大至肋缘下3cm，IGHV未突变，FISH检测存在del（11q），二代测序显示TP53突变阴性。由于诊断时具有贫血和血小板降低，符合iwCLL标准的治疗指征，一线予以BTK抑制剂（BTKi）伊布替尼420mg/d口服治疗，患者治疗6个月后疗效评价为：PR（淋巴细胞增多症），15个月后疗效评价为：PR且HB和PLT恢复了正常。患者在伊布替尼治疗持续48个月时出现了进行性乏力，并再次出现颈部、腋窝和腹股沟淋巴结增大；CBC示：WBC 79.4×10⁹/L、ALC 73.6×10⁹/L、HB 9.8g/l、PLT 80×10⁹/L，无自身免疫性溶血；明确为疾病进展。

针对这种在伊布替尼治疗过程中出现疾病进展的CLL患者，该如何选择下一步治疗方案呢？

BTKi治疗中进展的R/R CLL患者的注意事项

BTKi治疗过程中进展的CLL患者后续治疗选择及其疗效

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