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Individualizing 2L+ CLL Therapy

CME

Individualizing CLL Therapy: Second-Line Treatment and Beyond

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit™

Released: September 16, 2024

Expiration: August 15, 2025

CME/CE Information

Activity

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Introduction

In this activity, Jeremy S. Abramson, MD, MMSc; Farrukh Awan, MD; and Shuo Ma, MD, PhD, discuss factors in treatment decision-making for patients with chronic lymphocytic leukemia (CLL) who require second- or later-line therapy.  

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Some questions will be asked twice: once at the beginning of the activity and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

How many people with CLL do you provide care for in a typical month?

A 67-year-old male with CLL was treated with FCR 6 years ago and achieved a partial response (PR); however, at a follow-up visit, he complained of worsening fatigue. Examination showed lymphadenopathy and splenomegaly. Testing determined IGHV umutated CLL; FISH showed del(11q), and no TP53 mutation was noted on next-generation sequencing (NGS) panel. The patient has hypertension and is receiving treatment with hydrochlorothiazide. He was subsequently treated with single agent acalabrutinib and achieved PR. Five years later, he experienced worsening lymphocytosis, with a total WBC count 15 x 109/L, with 85% lymphocytes; hemoglobin and platelet count were normal. Peripheral blood flow cytometry confirmed relapsed CLL. Peripheral blood NGS panel showed a BTK C481S mutation and a TP53 mutation was noted.

In your current practice, what would you recommend for this patient?

A 72-year-old woman was initially treated for CLL with bendamustine + rituximab, resulting in a 7-year remission. She then developed symptomatic progression and was treated with venetoclax plus rituximab for 2 years, resulting in a 2-year remission. She again required treatment due to progressive lymphocytosis, cytopenia, and fatigue and received zanubrutinib, which she tolerated well but experienced disease progression after 3 years, after which she received pirtobrutinib. The patient experienced symptomatic disease progression 9 months later.

In your current practice, which of the following would you recommend for this patient?

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