Hallek M, Cheson BD, Catovsky D, et al; International Workshop on Chronic Lymphocytic Leukemia. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood. 2008;111:5446-5456. Erratum in: Blood. 2008;112:5259.
Shanafelt T. Treatment of older patients with chronic lymphocytic leukemia: key questions and current answers. Hematology Am Soc Hematol Educ Program. 2013;2013:158-167. Abstract
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Non-Hodgkin's lymphoma. Version 3.2016. 2016.
Wiestner A. The role of B-cell receptor inhibitors in the treatment of patients with chronic lymphocytic leukemia. Haematologica. 2015;100:1495-1507. Abstract
Thompson PA, Tam CS, O'Brien SM, et al. Fludarabine, cyclophosphamide, and rituximab treatment achieves long-term disease-free survival in IGHV-mutated chronic lymphocytic leukemia. Blood. 2016;127:303-309. Abstract
Zenz T, Mertens D, Küppers R, Döhner H, Stilgenbauer S. From pathogenesis to treatment of chronic lymphocytic leukaemia. Nat Rev Cancer. 2010;10:37-50. Abstract
Fischer K, Bahlo J, Fink AM, et al. Long-term remissions after FCR chemoimmunotherapy in previously untreated patients with CLL: updated results of the CLL8 trial. Blood. 2016;127:208-215. Abstract
Imbruvica® [package insert]. Horsham, PA: Pharmacyclics LLC; 2016.
Zydelig® [package insert]. Foster City, CA: Gilead Sciences; 2014.
Venclexta™ [package insert]. North Chicago, IL: Abbvie Inc; 2016.
Fischer K, Cramer P, Busch R, et al. Bendamustine in combination with rituximab for previously untreated patients with chronic lymphocytic leukemia: a multicenter phase II trial of the German Chronic Lymphocytic Leukemia Study Group. J Clin Oncol. 2012;30:3209-3216. Abstract
Foà R, Del Giudice I, Guarini A, et al. Clinical implications of the molecular genetics of chronic lymphocytic leukemia. Haematologica. 2013;98:675-685 Abstract
Jaglowski SM, Alinari L, Lapalombella R, et al. The clinical application of monoclonal antibodies in chronic lymphocytic leukemia. Blood. 2010;116:3705-3714. Abstract
Farooqui MZH, Valdez J, Martyr S, et al. Ibrutinib for previously untreated and relapsed or refractory chronic lymphocytic leukaemia with TP53 aberrations: a phase 2, single-arm trial. Lancet Oncol. 2015;16:169-176. Abstract
Byrd JC, Brown JR, O'Brien S, et al. Ibrutinib versus oftaumumab in previously treated chronic lymphoid leukemia. N Engl J Med. 2014;371:213-223. Abstract
Furman RR, Sharman JP, Coutre SE, et al. Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med. 2014;370:997-1007. Abstract
Byrd JC, Furman RR, Coutre SE, et al. Three-year follow-up of treatment-naive and previously treated patients with CLL and SLL receiving single therapy ibrutinib. Blood. 2015;125:2497-2506. Abstract
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CME / ABIM MOC

Personalized Therapy in Relapsed or Refractory CLL

Authors: Stephen J. Schuster, MD; Matthew S. Davids, MD; Amy Goodrich, CRNP
CME / ABIM MOC Released: 10/27/2016
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 10/27/2017, 11:59 PM EST

Target Audience and Goal Statement

This activity is intended for hematology and oncology specialists, pathologists, and radiologists.

The goal of this activity is to provide healthcare professionals an enhanced knowledge of optimal diagnosis, risk assessment, and therapeutic management strategies for patients with relapsed/refractory chronic lymphocytic leukemia (CLL) that take into consideration clinical and patient risk factors, prior therapies, and monitoring of therapy response.

Upon completion of this activity, participants will be able to:

Identify methods to tailor therapy for relapsed/refractory CLL based on factors such as prior therapy, cytogenetic and molecular features, and patient comorbidities/fitness
Develop a clinical management plan for a patient who has relapsed/refractory CLL
Differentiate emerging approaches for relapsed/refractory CLL as it relates to mechanism of action, efficacy, and safety

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Moderator

Stephen J. Schuster, MD

Robert & Margarita Louis-Dreyfus Professor of Chronic Lymphocytic Leukemia and Lymphoma, Hospital of the University of Pennsylvania; Director, Lymphoma Program & lymphoma Translational Research, Ruth & Raymond Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania

Disclosures

Disclosure: Stephen J. Schuster, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Celgene Corporation; Gilead Sciences, Inc.; Merck & Co., Inc.; Nordic Nanovector; Novartis Pharmaceuticals Corporation
Received grants for clinical research from: Celgene Corporation; Gilead Sciences, Inc.; Janssen Pharmaceuticals; Merck & Co., Inc.; Novartis Pharmaceuticals Corporation; Roche

Dr Schuster does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Schuster does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Panelists

Matthew S. Davids, MD

Instructor in Medicine; Associate Director, Center for Chronic Lymphocytic Leukemia, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts

Disclosures

Disclosure: Matthew S. Davids, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Celgene Corporation; Infinity Pharmaceuticals, Inc.; Genentech, Inc.; Gilead Sciences, Inc.; Janssen Pharmaceuticals; Pharmacyclics, Inc.; TG Therapeutics, Inc.
Received grants for clinical research from: Infinity Pharmaceuticals, Inc.; Genentech, Inc.; Pharmacyclics, Inc.; TG Therapeutics, Inc.

Dr Davids does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Davids does intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Amy Goodrich, CRNP

Research Associate, Johns Hopkins University, Baltimore, Maryland

Disclosures

Disclosure: Amy Goodrich, CRNP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Pharmacyclics, Inc.

Dr Goodrich does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Goodrich does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Steering Committee

Richard R. Furman, MD

Associate Professor of Medicine, Weill Cornell Medical College, New York, New York

Disclosures

Disclosure: Richard R. Furman, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Genentech, Inc.; Gilead Sciences, Inc.; Janssen Pharmaceuticals; Pharmacyclics, Inc.
Served as a speaker or a member of a speakers bureau for: AbbVie Inc.; Pharmacyclics, Inc.

Jennifer R. Brown, MD, PhD

Associate Professor of Medicine, Harvard Medical School; Director, CLL Center, Dana Farber Cancer Institute, Boston, Massachusetts

Disclosures

Disclosure: Jennifer R. Brown, MD PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Celgene Corporation; Genentech, Inc.; Gilead Sciences, Inc.; Janssen Pharmaceuticals; Infinity Pharmaceuticals; Pharmacyclics, Inc.; Pfizer Inc; Roche; Sun Biopharma

John C. Byrd, MD

Professor of Medicine, Medicinal Chemistry, and Veterinary Biosciences; Director, Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio

Disclosures

Disclosure: John C. Byrd, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Acerta Pharma
Received grants for clinical research from: Acerta Pharma

Amy Goodrich, CRNP

Disclosures

As listed above.

Neil E. Kay, MD

Professor of Medicine, Department of Hematology, Mayo Clinic, Rochester, Minnesota

Disclosures

Disclosure: Neil E. Kay, MD, has disclosed the following relevant financial relationships:
Received grants for clinical research from: Acerta Pharma; Celgene Corporation; Gilead Sciences, Inc.; Genentech, Inc.; Pharmacyclics, Inc.; Tolero Pharmaceuticals, Inc.
Served as a member of the Data and Safety Monitoring Committee for: Celgene Corporation; Gilead Sciences, Inc.; Infinity Pharmaceuticals, Inc.; MorphoSys; Pharmacyclics, Inc.

Jeff P. Sharman, MD

Director of Research, Willamette Valley Cancer Institute and Research Center; Medical Director of Hematology Research, US Oncology Network, Eugene, Oregon

Disclosures

Disclosure: Jeff P. Sharman, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: AbbVie Inc.; Genentech, Inc.; Gilead Sciences, Inc.; Pharmacyclics, Inc.; TG Therapeutics
Served as a speaker or a member of a speakers bureau for: Gilead Sciences, Inc.
Received for clinical research from: Genentech, Inc.; Gilead Sciences, Inc.; Pharmacyclics, Inc.; TG Therapeutics

Editors

Elaine Hamarstrom, PhD

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Elaine Hamarstrom, PhD, has disclosed the following financial relationships:
Received an Independent Educational Grant for Learning and Change from Pfizer, Inc.

Christina Loguidice

Medical Editor, Kendall Park, New Jersey

Disclosures

Disclosure: Christina Loguidice has disclosed no relevant financial relationships.

Christine Melton

Medical Editor, Kendall Park, New Jersey

Disclosures

Disclosure: Christine Melton has disclosed no relevant financial relationships.

CME Reviewer(s)

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

Accreditation Statements

Medscape, LLC is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.

For Physicians

Medscape, LLC designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Aggregate participant data will be shared with commercial supporters of this activity.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

Read the target audience, learning objectives, and author disclosures.
Study the educational content online or printed out.
Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. We encourage you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

*The credit that you receive is based on your user profile.

From Medscape Education Oncology

CME / ABIM MOC

Personalized Therapy in Relapsed or Refractory CLL

Authors: Stephen J. Schuster, MD; Matthew S. Davids, MD; Amy Goodrich, CRNPFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC Released: 10/27/2016

Valid for credit through: 10/27/2017, 11:59 PM EST

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Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Moderator

Stephen J. Schuster, MD

Panelists

Matthew S. Davids, MD

Amy Goodrich, CRNP

Steering Committee

Richard R. Furman, MD

Jennifer R. Brown, MD, PhD

John C. Byrd, MD

Amy Goodrich, CRNP

Neil E. Kay, MD

Jeff P. Sharman, MD

Editors

Elaine Hamarstrom, PhD

Christina Loguidice

Christine Melton

CME Reviewer(s)

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

CME / ABIM MOC

Personalized Therapy in Relapsed or Refractory CLL

Target Audience and Goal Statement

Disclosures

Moderator

Stephen J. Schuster, MD

Panelists

Matthew S. Davids, MD

Amy Goodrich, CRNP

Steering Committee

Richard R. Furman, MD

Jennifer R. Brown, MD, PhD

John C. Byrd, MD

Amy Goodrich, CRNP

Neil E. Kay, MD

Jeff P. Sharman, MD

Editors

Elaine Hamarstrom, PhD

Christina Loguidice

Christine Melton

CME Reviewer(s)

Amy Bernard, MS, BSN, RN-BC

Peer Reviewer

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Personalized Therapy in Relapsed or Refractory CLL