Would you ever consider using ibrutinib in CLL patients who have received first line acalabrutinib and then progressed?  

There is no benefit of switching between covalent BTKi (Acalabrutinib, zanubrutinib, or ibrutinib) especially in CLL which, in most cases, is driven by a C481S which renders all three ineffective. The only rationale situation to switch between the three would be intolerance. In this situation, switc...

Almost never - there have been rare exceptions (patient with no other options, not eligible for a clinical trial) - but based on resistance mechanisms and corroborated by real-world studies, we know that repeating a covalent BTKi in the setting of progression on a covalent BTKi gives only a temporar...

No. Ibrutinib binds to the same pocket in BTK as acalabrutinib and resistance mechanisms are similar. For such patients, I would consider venetoclax-based therapy or non covalent BTK inhibitors such as pirtobrutinib.