Sequencing in Relapsed/Refractory CLL

CE

Optimal Therapeutic Sequencing in Relapsed/Refractory CLL 

Physician Assistants/Physician Associates: 1.50 AAPA Category 1 CME credits

Nurses: 1.50 Nursing contact hours

Released: November 27, 2024

Expiration: May 26, 2025

Nichole Fisher
Nichole Fisher, RN, BSN
Amy Goodrich
Amy Goodrich, RN, MSN, CRNP-AC
Josie Montegaard
Josie Montegaard, MSN, AGPCNP-BC

Pretest

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

Currently, how confident are you in your ability to select and sequence treatment regimens and long-term treatment plans for individual patients with CLL/SLL to optimize clinical benefit?

2.

Per national guidance for treating patients with CLL, assessment of which of the following should be considered at baseline prior to initiation of a covalent BTK inhibitor?

3.

Case Continued: Patient With Previously Treated CLL



  • Joe returned to clinic for routine 3-mo follow up

    • Felt more fatigued: was taking shorter walks and napping daily

    • Occasional drenching night sweats ~3-4x/month

    • Eating well, without weight loss

    • Physical exam notable for 2-3 cm bilat axillary/inguinal lymph nodes



  • APP concerned for progressive disease

  • Repeat testing showed del(13q), (11q), and BTK C481S mutation (present since progression on acalabrutinib)

  • Lab Results:

    • White blood cell count (WBC): 56.0 K/μL

    • Absolute lymphocyte count (ALC): 53.2 K/μL

    • Absolute neutrophil count (ANC): 2.8 K/μL

    • Hemoglobin (Hb): 10.2 g/dL

    • Platelets (plt): 121 K/μL

    • Normal CMP and LDH



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