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BTK Inhibitors for CLL: Data Updates and Optimizing Patient Care

  • Authors: John M. Pagel, MD, PhD
  • CME / ABIM MOC / CE Released: 9/27/2021
  • Valid for credit through: 9/27/2022
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Target Audience and Goal Statement

This activity is intended for hematologists/oncologists, nurse practitioners, nurses, and others involved in the care of patients with CLL.

The goal of this activity is to improve the knowledge of hematologists/oncologists, nurses, and nurse practitioners regarding the safety and efficacy of BTK inhibitors in CLL as well as their competence in using these agents and managing adverse events (AEs).

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Recent clinical trial data comparing BTK inhibitors in relapsed/refractory CLL
    • AE profiles of available BTK inhibitors in CLL
  • Have greater competence related to
    • Managing AEs associated with BTK inhibitors
    • Educating patients about possible AEs associated with BTK inhibitors
  • Demonstrate greater confidence in their ability to
    • Identify patients with CLL who are appropriate candidates for BTK inhibitors


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  • John M. Pagel, MD, PhD

    Chief of Hematologic Malignancies
    Center for Blood Disorders and Stem Cell Transplantation
    Swedish Cancer Institute
    Seattle, Washington


    Disclosure: John M. Pagel, MD, PhD, has the following relevant financial relationships:
    Advisor or consultant for: Actinium; AstraZeneca; Epizyme; Loxo; MEI Pharma
    Speaker or a member of a speakers bureau for: BeiGene; Gilead; MorphoSys


  • Megan Whitney, DMD

    Medical Education Director, Medscape, LLC 


    Disclosure: Megan Whitney, DMD, has disclosed no relevant financial relationships. 

  • Tristin Abair, PhD

    Senior Medical Writer, Medscape, LLC 


    Disclosure: Tristin Abair, PhD, has disclosed no relevant financial relationships.

CME Reviewer

  • Esther Nyarko, PharmD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Disclosure: Esther Nyarko, PharmD, has disclosed no relevant financial relationships.

Nurse Planner

  • Leigh Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Disclosure: Leigh Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.

Peer Reviewer

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

Accreditation Statements

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

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  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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    For Nurses

  • Awarded 1.0 contact hour(s) of nursing continuing professional development for RNs and APNs; 1.0 contact hours are in the area of pharmacology.

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BTK Inhibitors for CLL: Data Updates and Optimizing Patient Care

Authors: John M. Pagel, MD, PhDFaculty and Disclosures

CME / ABIM MOC / CE Released: 9/27/2021

Valid for credit through: 9/27/2022



The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Olivia is a 71-year-old retired teacher who stays active helping her children and grandchildren. Her medical history includes well-controlled diabetes, mild renal insufficiency, and early osteoporosis. During a routine physical, her bloodwork showed lymphocytosis, with a white blood cell (WBC) count of 38,000/mm3. A full hematology workup showed monoclonal lambda-expressing B cells, with an immunophenotype by flow cytometry consistent with chronic lymphocytic leukemia (CLL) (Table 1). Molecular analysis showed no mutations in IGHV or TP53. Fluorescence in situ hybridization analysis shows deletion 13q (del(13q)) and no other adverse chromosomal abnormalities. She is currently asymptomatic.

Table 1. Olivia's Initial Workup

Demographics/patient information
  • 71 years old, female
  • Height: 5 ft 4 in; weight: 150 lb
  • BMI: 25.7
Personal and family medical history
  • History of diabetes, mild renal insufficiency, and early osteoporosis
  • No major surgeries
  • Current medications include glimepiride and ibandronate
  • No family history of cancer
Physical examination
  • No lymphadenopathy
  • No splenomegaly or hepatomegaly
  • BP: 130/85 mm HG; HR: 70 bpm
  • ECOG PS: 0
  • 75 mL/min
  • WBC count: 38,000/mm3
  • Hb: 11.3 g/dL
  • Platelets: 132,000/mm3
Flow cytometry
  • Immunophenotype: CD5+, CD19+, CD23+, CD43+, CD79b+, CD200+, CD20-low
  • Del(13q)
  • No other chromosomal abnormalities identified
Molecular analysis
  • Unmutated IGHV
  • No TP53 mutations
BMI, body mass index; BP, blood pressure; bpm, beats per minute; CBC, complete blood cell count; CrCl, creatinine clearance; ECOG, Eastern Cooperative Oncology Group; Hb, hemoglobin; HR, heart rate; PS, performance status; WBC, white blood cell.

You sit down with Olivia and her husband to discuss her diagnosis and appropriate next steps.

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