Due to the 17p deletion, chemoimmunotherapy would not be a good option. Therefore, the options for first line therapy would be a BTK inhibitor or venetoclax + obinutuzumab. The decision between them usually comes down to comorbidities and patient preference. In patients who are at increased bleeding risk and/or are on blood thinners or who have cardiac issues then I typically go with venetoclax + obinutuzumab over BTK inhibitors. For patients who have bad cytopenias or high disease burden I typically will use a BTK inhibitor due to the risk of worsening cytopenias or tumor lysis syndrome with ventoclax. In patients who don't have these factors I usually discuss the pros/cons of each and let them decide. BTK inhibitors are given indefinitely until disease progression, but patients don't have to come in frequently for infusions. Venetoclax + obinutuzumab is given for a fixed duration of 12 months but requires frequent visits for infusions. Some patients will have a strong preference for one or the other. With BTK inhibitors, I typically use either zanubrutinib or acalabrutinib over ibrutinib because they have at least similar efficacy as ibrutinib with less toxicity.