Chronic Lymphocytic Leukemia

The FDA has granted a breakthrough therapy designation to acalabrutinib (Calquence) for the treatment of patients with chronic lymphocytic leukemia.

The European Commission has expanded the approval of ibrutinib to include use in combination with obinutuzumab for adult patients with previously untreated chronic lymphocytic leukemia, and also in combination with rituximab for the treatment of adult patients with Waldenström macroglobulinemia.

Sameem Abedin, MD, assistant professor, Medical College of Wisconsin, discusses the use of PI3K inhibitors in the treatment of patients with chronic lymphocytic leukemia (CLL).

Jeff Sharman, MD, director of research at Willamette Valley Cancer Institute and medical director of hematology research for The US Oncology Network, discusses the potential future of acalabrutinib (Calquence) in chronic lymphocytic leukemia (CLL).

David A. Bond, MD, assistant professor, The Ohio State University, discusses the high rates of second cancers in both treatment-naïve and pretreated patients with chronic lymphocytic leukemia who received BTK inhibitors.

Tanya Siddiqi, MD, a hematologist/oncologist at City of Hope, discusses the CLL14 trial, which tested venetoclax (Venclexta) plus obinutuzumab (Gazyva) versus obinutuzumab plus chlorambucil in patients with previously untreated chronic lymphocytic leukemia and coexisting conditions.

The FDA has approved PF-05280586, a biosimilar for rituximab, for the treatment of adult patients with CD20-positive B-cell non-Hodgkin lymphoma as a single agent or in combination with chemotherapy, or for patients with CD20-positive chronic lymphocytic leukemia in combination with chemotherapy.

Mazyar Shadman, MD, MPH, assistant member, Clinical Research Division, Fred Hutchinson Cancer Research Center, assistant professor, Medical Oncology Division, University of Washington School of Medicine, and attending physician, Hematologic Malignancies, Seattle Cancer Care Alliance, discusses the phase III CLL14 trial in chronic lymphocytic leukemia (CLL).

Monocytic myeloid-derived suppressor cells increased with ibrutinib treatment in a preclinical model of chronic lymphocytic leukemia, suggesting a role for ITK inhibition in this cell population.

Brian T. Hill, MD, PhD, highlights the latest data with BTK inhibitors in chronic lymphocytic leukemia.

Jennifer Woyach, MD, discusses a 3-year follow-up looking at acalabrutinib with obinutuzumab in treatment-naïve and relapsed/refractory chronic lymphocytic leukemia.

Rafic Farah, MD, provides an in-depth look at the trials that now define standards of care among patients with newly diagnosed and relapsed/refractory chronic lymphocytic leukemia.

Mazyar Shadman, MD, MPH, assistant member, Clinical Research Division, Fred Hutchinson Cancer Research Center, assistant professor, Medical Oncology Division, Department of Medicine, University of Washington School of Medicine, and attending physician, Seattle Cancer Care Alliance, discusses fixed durations of treatment in chronic lymphocytic leukemia (CLL).

For patients with chronic lymphocytic leukemia, including those with high-risk disease, the availability of novel targeted therapies and monoclonal antibodies offers an increased potential for improved outcomes.

There have been updates in chronic lymphocytic leukemia prevalence and diagnosis, with an emphasis on testing options.

In December 2018, pivotal trial data were presented at the ASH Annual Meeting that demonstrated promising results for the first-line treatment of patients with chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia. In particular, new courses of CLL care in several patient populations emerged from the findings of 3 trials.

Jennifer Woyach, MD, discusses the current treatment spectrum of chronic lymphocytic leukemia and the significance of the ALLIANCE trial.

Matthew S. Davids, MD, MMSc, characterizes the significance of the ALLIANCE, ECOG E1912, and iLLUMINATE trials within the broader treatment spectrum for chronic lymphocytic leukemia.

The European Medicines Agency’s Committee for Medicinal Products for Human Use has recommended expanding the indications of ibrutinib (Imbruvica) to include use in combination with obinutuzumab (Gazyva) for adult patients with previously untreated chronic lymphocytic leukemia, and also in combination with rituximab (Rituxan) for the treatment of adult patients with Waldenström’s macroglobulinemia.

Jennifer Woyach, MD, discusses the 3-year follow-up from the single-arm study of the combination of acalabrutinib (Calquence) and obinutuzumab (Gazyva) showcase the efficacy of the regimen in both patients with treatment-naïve and relapsed/refractory chronic lymphocytic leukemia and the future of treatment in the space.

Patients with high-risk relapsed/refractory chronic lymphocytic leukemia who failed or were intolerant of ibrutinib derived more benefit from CD19‐targeted CAR T-cell therapy when the BTK inhibitor was concurrently administered than when it was not.

Tanya Siddiqi, MD, a hematologist/oncologist at City of Hope, discusses the phase I/II TRANSCEND CLL 004 trial, which evaluated the efficacy of anti-CD19 CAR T cells in patients with relapsed/refractory chronic lymphocytic leukemia or small lymphocytic lymphoma.

The CAR T-cell therapy lisocabtagene maraleucel demonstrated high rates of response, including minimum residual disease in blood and marrow in patients with relapsed/refractory chronic lymphocytic leukemia or small lymphocytic lymphoma.

Acalabrutinib elicited high rates of response as well as prolonged survival and was well tolerated in patients with chronic lymphocytic leukemia who demonstrated intolerance to ibrutinib.

In a careful evaluation of chemotherapy‐free regimens, the combination of obinutuzumab plus venetoclax compared to obinutuzumab plus chlorambucil, objective and complete response rates, as well as progression-free survival were superior with the venetoclax combination in the overall study population and across all genetic subgroups evaluated in patients with chronic lymphocytic lymphoma.