Introduction
CARE™ Hematology Faculty lead, Dr. Peter Anglin, connects virtually with Dr. Versha Banerji to discuss Considerations for treatment rrCLL.
Case
John – aged 76 relapses after 5 years on Ibrutinib
Lives 30 minutes from hospital
Diabetes with stable coronary disease
- Has had remote PCI
- Takes aspirin and 3-4 other meds
When placed on Ibrutinib it was unmutated and no evidence of del17p
- Has done very well on over the past 5 years at 420 mg/daily
In past 6 months has developed progressive lymphadenopathy
- Rise of white count to 46. (Lymphocytes at 20, six months ago).
Key Discussion Points
- How long do you follow a gradual relapse before you say “it is time [to transition to next line of therapy]?”
- Do you do FISH studies with patients at first relapse?
- What is your treatment of choice as next line of therapy?
- Patient has del17p do you favour …continuous Ven monotherapy over finite Ven+R?
Variants on case
Patient is converted to Ven based regimen and developed significant neutropenia in week 2
- How do you manage neutropenia on Ven therapy?
3rd line options?
Related content/additional resources:
CARE™ Hematology Faculty lead, Dr. Peter Anglin (Stronach Regional Cancer Centre, ON), connected virtually with international expert Dr. Stephan Stilgenbauer to discuss Considerations for treatment of two separate cases in frontline CLL.
Case 1 a typical
72 year-old patient is IgHV unmutated, no Del17p or TP53.
Case 2 – atypical
58 year-old active/fit female, IgHV mutated with normal cytogenetics. Requires therapy.
You can access this link by Clicking Here.
CARE™ Hematology Faculty lead, Dr. Peter Anglin (Stronach Regional Cancer Centre, ON), connected virtually with international expert Dr. John Seymour (Peter MacCallum Cancer Centre, Australia) earlier in summer to discuss how standards have evolved and considerations relevant to CLL treatment decisions in today’s landscape.
You can access this link by Clicking Here.
