Oncology

Chronic Lymphocytic Leukemia

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Chronic Lymphocytic Leukemia: Disease-Specific Knowledge and Perspectives in Real-World Patients

patient care perspectives by Sameer A. Parikh, MBBS
Overview

Understanding a patient’s knowledge and attitudes about their chronic lymphocytic leukemia (CLL) can support shared decision making and active engagement in treatment. This is particularly true for older patients, who can experience more significant challenges with treatment.

Expert Commentary
“There are many effective treatment options available for patients with CLL, and we have the luxury of choosing the treatment that we think will benefit patients the most. Understanding where the patient is coming from, particularly with regard to their knowledge about CLL, their expectations for treatment, and their knowledge of expected toxicities from our most commonly used treatments, is very important.”
— Sameer A. Parikh, MBBS

There are many effective treatment options available for patients with CLL, and we have the luxury of choosing the treatment that we think will benefit patients the most. Understanding where the patient is coming from, particularly with regard to their knowledge about CLL, their expectations for treatment, and their knowledge of expected toxicities from our most commonly used treatments, is very important.

 

Many patients with CLL are already taking medicines for other chronic medical conditions such as hypertension or diabetes. For these individuals, adding another oral pill that they would take continuously does not seem to be that difficult. They are often comfortable with continuous BTK inhibitor–based treatments that can go on for several years. On the other hand, there are also many patients who dislike continuous treatment regimens because they are associated not only with physical toxicity but also with financial toxicity. It is also important to remember that, although continuous oral BTK inhibitor treatment seems attractive, there can be serious adverse events associated with their use, and proper counseling regarding the pros and cons of starting these treatments is very important in routine clinical practice.

 

Some individuals prefer fixed-duration therapy, which is typically venetoclax-based treatment. Administering venetoclax for a time-limited duration of 1 or 2 years, either in the frontline or the relapsed/refractory setting, can help control the disease very well and can lead to durable, long-term, treatment-free remissions. There are unique toxicities associated with venetoclax-based treatment; hence, a careful discussion about the risks and benefits of this treatment seems warranted as well. I think that the choice between BTK inhibitor– and BCL-2 inhibitor–based treatment remains open until we have randomized data to inform which approach is best from an efficacy and safety perspective. So, an honest discussion about what the patient and their family desire is exceedingly important.

References

Chung C, Umoru G, Abboud K, Hobaugh E. Sequencing and combination of current small-molecule inhibitors for chronic lymphocytic leukemia: where is the evidence? Eur J Haematol. 2023;111(1):15-28. doi:10.1111/ejh.13973

 

O’Brien SM, Brown JR, Byrd JC, et al. Monitoring and managing BTK inhibitor treatment-related adverse events in clinical practice. Front Oncol. 2021;11:720704. doi:10.3389/fonc.2021.720704

 

Tam C, Pinilla-Ibarz J, Castillo CG, et al. Results of VOICE: a global survey of disease-specific knowledge and perspectives of real-world patients with CLL. Blood Adv. 2023;7(22):6819-6828. doi:10.1182/bloodadvances.2023010879

Sameer A. Parikh, MBBS

    Consultant, Associate Professor of Medicine, and Assistant Professor of Oncology
    Division of Hematology, Department of Internal Medicine
    Mayo Clinic
    Rochester, MN
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