Chronic Lymphocytic Leukemia (CLL) is the most prevalent type of adult leukemia, with a median age of diagnosis of 72. However, 10 percent of patients are under age 50, twice as common in men as it is in women. There is a genetic predisposition; an environmental predisposition is uncertain, although Vietnam Veterans with Agent Orange exposure warrant “service connected” disability status.
The stats above were discussed, along with clinical trial results and case studies, by Dr. John C. Byrd, Director of the Division of Hematology at Ohio State University. He explains how to best answer the big question at diagnosis in asymptomatic patients, “How will this ‘bad’ leukemia influence my quality of life and life expectancy?” You can watch the full, complimentary on-demand CME session at OMedLive.com.
Diagnosis for CLL
The initial workup for CLL patients includes such tests as flow cytometry (to confirm diagnosis), Beta-2-microglobulin, PET scans if Richter’s is suspected; bone marrow biopsy and aspirate are not necessary in the absence of cytopenias. Autoimmune cytopenias are common (10-25%) in CLL and often present when the disease is active.
Though they do not influence staging, the approach of autoimmune hemolytic anemia (AIHA) and thrombocytopenia requires assessment of secondary causes and relationship to disease or therapy which can include prednisone, rituximab, IVIG, cyclosporine, splenectomy, and romiplostim (ITP).
Referencing the studies, Dr. Byrd says there is “no advantage to treating CLL until symptoms develop irrespective of genomic features.” The most common causes of morbidity and mortality in CLL are with bacterial, viral, and later opportunistic infections; it is often difficult to link the cause to the disease or the treatment. Dr. Byrd explains several preventive strategies in treating infections and other CLL-related complications. Differentiating patients for treatment is based on age or functional status and genomic features.
When seeking to answer “what is the best therapy for CLL treatment,” Dr. Byrd calls on CLL10 data from German CLL Group, long term FCR data from MDA FCR300 series, and German CLL VIII data relative to ‘curability.’ Dr. Byrd dives into the data showing hazard of progression, OS, prevalence of secondary tumors, progression-free status, and long-term follow up.
Consideration for Patients under 70
Special considerations must be given to elderly patients as compared with those less than 70 years of age including the use of non Fludarabine-based regimens and combinations of other medications which are not used in the younger sector. One medication being used is GA101 (Obinutuzumab). It is a humanized monoclonal antibody targeting CD20 with novel properties as compared to rituximab.
Dr. Byrd tackles considerations for relapsed CLL, explaining the outcome of patients at time of relapse depend upon interphase cytogenetics, prior therapy, and time of remission with last treatment. He cautions to treat relapsed patients only when they are symptomatic. The presentation ends sharing important conclusions related to CLL. Indicated here are select genomic studies which can assist in risk stratification. Also, kinase inhibitors such as ibrutinib have somewhat altered the recommended time for transplant in CLL.
For more details on the clinical trial results, case studies, demographic specific treatment strategies, and more important considerations, please visit OMEDLIVE or click this link to be taken directly to “Selecting Treatment Strategies for Chronic Lymphocytic Leukemia and Small Lymphocytic Leukemia.”
Disclaimer: All OMEDLIVE articles, reports, summaries, and recaps of events are for informational purposes. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.
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