National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Chronic lymphocytic leukemia/small lymphocytic leukemia. (Version 4.2021). Published April 29, 2021. Accessed August 26, 2021. https://www.nccn.org/professionals/physician_gls/pdf/cll.pdf
Hallek M, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131:2745-2760.
Ibrutinib [PI]. Approved 2013. Revised August 2020.
Acalabrutinib [PI]. Approved 2017. Revised November 2019.
Venetoclax [PI]. Approved 2016. Revised November 2020.
Kater AP, et al. Fixed-duration ibrutinib and venetoclax (I+V) versus chlorambucil plus obinutuzumab (CLB+O) for first-line (1L) chronic lymphocytic leukemia (CLL): primary analysis of the phase 3 GLOW study. Presented at: European Hematology Association Virtual Congress; June 9-17, 2021. Presentation LB1902.
Allan JN, et al. Primary analysis of the fixed-duration cohort from the phase 2 CAPTIVATE study of first-line ibrutinib + venetoclax for chronic lymphocytic leukemia/small lymphocytic lymphoma. Presented at: European Hematology Association Virtual Congress; June 9-17, 2021. Presentation S147.
Barr PM, et al. Up to seven years of follow-up in the RESONATE-2 study of first-line ibrutinib treatment for patients with chronic lymphocytic leukemia. Poster presented at: American Society of Clinical Oncology 57th Annual Meeting Virtual; June 4-8, 2021. Poster 7523.
Moreno C, et al. Ibrutinib plus obinutuzumab versus chlorambucil plus obinutuzumab in first-line treatment of chronic lymphocytic leukaemia (iLLUMINATE): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2019;20:43-56.
Woyach JA, et al. Ibrutinib regimens versus chemoimmunotherapy in older patients with untreated CLL. N Engl J Med. 2018;379:2517-2528.
Sharman JP, et al. Acalabrutinib ± obinutuzumab versus obinutuzumab + chlorambucil in treatment-naïve chronic lymphocytic leukemia: ELEVATE-TN four-year follow up. Poster presented at: American Society of Clinical Oncology Annual Meeting Virtual; June 4-8, 2021. Poster 7509.
Fischer K, et al. Venetoclax and obinutuzumab in patients with CLL and coexisting conditions. N Engl J Med. 2019;380:2225-2236.
Al-Sawaf O, et al. Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 4-year follow-up analysis of the randomized CLL14 study. Presented at: European Hematology Association Virtual Congress; June 9-17, 2021. Presentation S146.
Jones GL, et al. Guidelines for the management of tumour lysis syndrome in adults and children with haematological malignancies on behalf of the British Committee for Standards in Haematology. Br J Haematol. 2015;169:661-671.
Gribben JG. Practical management of tumour lysis syndrome in venetoclax-treated patients with chronic lymphocytic leukaemia. Br J Haematol. 2020;188:844-851.
Rocque GB, et al. Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education. Transl Behav Med. 2018;8:175-182.
Lipsky A, et al. Managing toxicities of Bruton tyrosine kinase inhibitors. Hematology Am Soc Hematol Educ Program. 2020;2020:336-345.
Burger JA, et al. Long-term efficacy and safety of first-line ibrutinib treatment for patients with CLL/SLL: 5 years of follow-up from the phase 3 RESONATE-2 study. Leukemia. 2020;34:787-798.
Munir T, et al. Final analysis from RESONATE: up to six years of follow-up on ibrutinib in patients with previously treated chronic lymphocytic leukemia or small lymphocytic lymphoma. Am J Hematol. 2019;94:1353-1363.
Ghia P, et al. ASCEND: phase III, randomized trial of acalabrutinib versus idelalisib plus rituximab or bendamustine plus rituximab in relapsed or refractory chronic lymphocytic leukemia. J Clin Oncol. 2020;38:2849-2861.
Wierda WG, et al. Ibrutinib (Ibr) plus venetoclax (Ven) for first-line treatment of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL): 1-year disease-free survival (DFS) results from the MRD cohort of the phase 2 CAPTIVATE study. Presented at: American Society of Hematology 2020 Virtual; December 5-8, 2020. Presentation 123.
Hallek M. Chronic lymphocytic leukemia: 2020 update on diagnosis, risk stratification and treatment. Am J Hematol. 2019;94:1266-1287.
Byrd JC, et al. First results of a head-to-head trial of acalabrutinib versus ibrutinib in previously treated chronic lymphocytic leukemia. Presented at: 2021 American Society of Clinical Oncology Annual Meeting Virtual; June 4-8, 2021. Presentation 7500.
Hillmen P, et al. First interim analysis of ALPINE study: results of a phase 3 randomized study of zanubrutinib vs ibrutinib in patients with relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma. Presented at: European Hematology Association Virtual Congress; June 9-17, 2021. Presentation LB1900.

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Faculty

John M. Pagel, MD, PhD

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

Disclosures

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

Editors

Megan Whitney, DMD

Medical Education Director, Medscape, LLC 

Disclosures

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

Tristin Abair, PhD

Senior Medical Writer, Medscape, LLC 

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

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Esther Nyarko, PharmD

Associate Director, Accreditation and Compliance, Medscape, LLC

Disclosures

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

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

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CME / ABIM MOC / CE

BTK Inhibitors for CLL: Data Updates and Optimizing Patient Care

Authors: John M. Pagel, MD, PhD
CME / ABIM MOC / CE Released: 9/27/2021
THIS ACTIVITY HAS EXPIRED FOR CREDIT
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

Disclosures

Faculty

John M. Pagel, MD, PhD

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

Disclosures

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

Editors

Megan Whitney, DMD

Medical Education Director, Medscape, LLC 

Disclosures

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

Tristin Abair, PhD

Senior Medical Writer, Medscape, LLC 

Disclosures

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

CME Reviewer

Esther Nyarko, PharmD

Associate Director, Accreditation and Compliance, Medscape, LLC

Disclosures

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

Disclosures

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

Peer Reviewer

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

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From Medscape Education Oncology

CME / ABIM MOC / CE

BTK Inhibitors for CLL: Data Updates and Optimizing Patient Care

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

THIS ACTIVITY HAS EXPIRED FOR CREDIT

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

Valid for credit through: 9/27/2022

processing....

For Your Patient

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.

CASE 1: PATIENT HISTORY AND PRESENTATION

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

	Results
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
CrCl	75 mL/min
CBC	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
Cytogenetics/FISH	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.

Page 1 of 13

CME / ABIM MOC / CE Information

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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, whether living or deceased, is intended or should be inferred. The material presented here does not necessarily reflect the views of Medscape, LLC, or any individuals or commercial entities that support companies that support educational programming on medscape.org. These materials may include discussion of therapeutic products that have not been approved by the US Food and Drug Administration, off-label uses of approved products, or data that were presented in abstract form. These data should be considered preliminary until published in a peer-reviewed journal. Readers should verify all information and data before treating patients or employing any therapies described in this or any educational activity. A qualified healthcare professional should be consulted before using any therapeutic product discussed herein.

References

Faculty and Disclosures

Faculty

John M. Pagel, MD, PhD

Editors

Megan Whitney, DMD

Tristin Abair, PhD

CME Reviewer

Esther Nyarko, PharmD

Nurse Planner

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

Peer Reviewer

CME / ABIM MOC / CE

BTK Inhibitors for CLL: Data Updates and Optimizing Patient Care

Target Audience and Goal Statement

Disclosures

Faculty

John M. Pagel, MD, PhD

Editors

Megan Whitney, DMD

Tristin Abair, PhD

CME Reviewer

Esther Nyarko, PharmD

Nurse Planner

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

Peer Reviewer

Accreditation Statements

For Physicians

For Nurses

Instructions for Participation and Credit

BTK Inhibitors for CLL: Data Updates and Optimizing Patient Care

For Your Patient

CASE 1: PATIENT HISTORY AND PRESENTATION

PDF Downloads

Megan Whitney, DMD

Megan Whitney, DMD