The activity of ibrutinib was studied in 40 high risk CLL patients (20 patients with 17p del) showed that 87% achieved PR and 8% CR. Responses were seen early, most patients had a more than 50% reduction in lymph nodes at their first radiographic response assessment after 12 months on therapy. Median progression free survival at 18 months was 78% of all patients and deletion 17p had 72%. Future studies are being conducted to evaluate the whether the addition of Rituximab to ibrutinib will create a longer PFS and OS in relapsed and refractory CLL