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Individualizing Therapy Selection in CLL

CE / CME

Applying the Evidence in CLL/SLL: Best Practices for Individualizing Therapy Selection

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Pharmacists: 1.00 contact hour (0.1 CEUs)

Nurse Practitioners/Nurses: 1.00 Nursing contact hour, including 1.00 hour of pharmacotherapy credit

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: July 25, 2025

Expiration: January 24, 2026

Sameer A. Parikh
Sameer A. Parikh, MBBS
CME/CE Information

Pretest

Progress
1 2 3
Course Completed
Please answer the questions below.
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1.

Which of the following accurately describes the novel BTK inhibitor nemtabrutinib?

2.

Case 1: Patient With Previously Untreated CLL



  • An 80-yr-old man with history of AO exposure during military service presents in follow-up for his CLL

    • Diagnosed in 2018 with lymphocytosis and monitored with a watch-and-wait strategy



  • Normal cytogenetics and unmutated IGHV

  • CBC shows peripheral blood lymphocytosis up to 120,000 K/μL from 70,000 K/μL 3 mo ago; patient complains of unintentional weight loss and drenching night sweats increasing in frequency over the past 6 wk

  • Comorbidities significant for controlled HTN and CKD (EGFR 40 mL/min); ECOG PS 1

  • He lives 45 min from the infusion center and strongly prefers not to drive there if he can avoid it 

In your current practice, what would you consider to be the optimal therapy for this patient?

3.

Case 2: Patient With Relapsed CLL After BTK Inhibitor and Venetoclax-Based Therapy



  • A 64-yr-old man was diagnosed with Rai stage IV CLL in 2016

    • Apart from hypertension, he has no significant medical history

    • Molecular features: unmutated IGHV, del11q by FISH, and no TP53 mutation by NGS



  • His treatment history is as follows:

    • Ibrutinib and rituximab from 7/2016 through 1/2020; progression

    • Venetoclax and obinutuzumab from 2/2020 with excellent response; continued single-agent venetoclax



  • He returns for follow up in January 2025 with mild fatigue

    • Physical examination: lymphadenopathy with cervical and axillary lymph nodes measuring 2 x 2 cm; no splenomegaly; ECOG PS 0

    • WBC count increased to 18 x 109/L (85% lymphocytes), Hb 10.8 g/dL; platelet count 105 x 109/L

    • Repeat CLL FISH panel showed del11q and no other abnormalities; NGS profile of peripheral blood showed a new TP53 mutation

    • CT chest, abdomen, and pelvis demonstrated worsening generalized lymphadenopathy, with the largest lymph node in the retroperitoneum measuring 3 x 4 cm in size; spleen was 16 cm 



In your current practice, what would you consider to be the optimal therapy for this patient?

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