Updates in the Management of CLL: Histologic Transformation and Relapsed/Refractory Disease
Histologic transformation of chronic lymphocytic leukemia (CLL) to more aggressive lymphoma is associated with a poor prognosis since it is typically resistant to standard chemoimmunotherapy regimens used for the treatment of CLL. The management of histologic transformation of CLL to aggressive lymphomas is an unmet clinical need since the standard of care is not established. Precise diagnosis of transformation and the identification of specific genetic abnormalities implicated in the pathogenesis of histologic transformation will enable individualized treatment approaches for improving the clinical outcomes. Oncologists and hematologists need to understand unique challenges associated with the management of histologic transformation of CLL. The therapeutic landscape of relapsed or refractory CLL has evolved significantly in recent years with the advent of small molecule inhibitors targeted against the key signaling pathways involved in the pathogenesis of CLL. Targeted therapy with small molecule inhibitors has emerged as the new standard of care for the treatment of relapsed/refractory disease including CLL with del(17p)/TP53 mutation. In addition to the individual patient and disease characteristics, the selection of treatment for relapsed or refractory CLL is also dependent on the response to previous treatment. Hematologists and oncologists need to be informed about the new treatment strategies to help them incorporate these findings more effectively into their clinical practice. Maintaining a current knowledge of recent advances and ongoing research is important in helping oncologists/hematologists incorporate novel therapies into routine clinical practice in the appropriate patient population to improve clinical outcomes.
This information was originally presented at the NCCN 13th Annual Congress: Hematologic Malignancies™ held in New York, New York, from September 21-22, 2018.
This educational program is designed to meet the educational needs of oncologists, hematologists, nurses, pharmacists, and other health care professionals who manage patients with hematologic malignancies.
Following this activity, participants should be able to:
- Describe the current treatment options and the rationale for the development of more effective strategies for the management of histologic transformation of CLL.
- Review evidence from clinical trials supporting the use of small molecule inhibitors for the treatment of relapsed/refractory CLL.
- Develop an individualized treatment plan for relapsed/refractory CLL based on prior treatment and the presence of cytogenetic abnormalities.
John N. Allan, MD
Weill Cornell Medicine
Deborah Stephens, DO
Huntsman Cancer Institute at the University of Utah
Disclosure of Relevant Financial Relationships
All faculty and activity planners participating in NCCN continuing education (CE) activities are expected to disclose any relevant financial relationships with a commercial interest as defined by ACCME’s, ACPE’s, and ANCC’s Standards for Commercial Support. All faculty presentations have been reviewed for adherence to ACCME’s Criterion 7: The provider develops activities/educational interventions independent of commercial interests (SCS 1, 2, and 6) by experts on the topics. Full disclosure of faculty relationships will be made prior to the activity.
NCCN continuing education considers financial relationships to create a “conflict of interest” when an individual has both a financial relationship with a commercial interest and the opportunity to affect CE content about the products or services of a commercial interest with which he/she and/or a spouse or partner has a financial relationship.
NCCN continuing education considers “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. NCCN does not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship.
All faculty for this continuing education activity are competent in the subject matter and qualified by experience, training, and/or preparation for the tasks and methods of delivery.
Faculty presentations may include discussion of off-label use. Faculty will disclose that the use in question is not currently approved by the FDA per the product labeling.
The faculty listed below discloses no relevant financial relationships:
Deborah Stephens, DO
The faculty listed below discloses the following relevant financial relationships:
John N. Allan, MD
AbbVie, Inc.: Scientific Advisor
Acerta Pharma: Scientific Advisor
Genentech, Inc.: Scientific Advisor
Pharmacyclics: Scientific Advisor
Sunesis: Scientific Advisor
Verastem Oncology: Scientific Advisor
NCCN Staff Disclosures
The NCCN Activity Planning staff listed below discloses no relevant financial relationships:
Robert W. Carlson, MD; Melissa Esplen; Mark A. Geisler; Kristina M. Gregory, RN, MSN, OCN; Kristin Kline Hasson; Rose Joyce; Karen Kanefield; Lisa G. Kimbro, MBA, CPA (employed by NCCN until 8/10/2018); Joan S. McClure, MS (employed by NCCN until 8/1/2018); Lisa Perfidio, MS; Shannon Ryan; Kathy Ann Smith, CMP, CHCP; Gary J. Weyhmuller, MBA, SPHR
The NCCN Activity Planning staff listed below discloses the following relevant financial relationships:
Donald Harting, ELS, CHCP
Laboratory Corporation of America (LabCorp): Equity interest/Stock Options
Pfizer Inc.: Equity Interest/Stock Options
Boston Scientific Corporation: Equity Interest/Stock Options
The NCCN Clinical staff listed below discloses no relevant financial relationships:
Mary A. Dwyer, MS, CGC; Hema Sundar, PhD
National Comprehensive Cancer Network is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
NCCN designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. PAs may receive a maximum of 0.50 hour of Category 1 credit for completing this activity.
National Comprehensive Cancer Network (NCCN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
NCCN designates this educational activity for a maximum of 0.50 contact hour.
|National Comprehensive Cancer Network is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.|
NCCN designates this knowledge-based continuing education activity for 0.50 contact hour (0.05 CEUs) of continuing education credit. UAN: 0836-0000-18-119-H01-P
- 0.50 ACPE contact hours
- 0.50 AMA PRA Category 1 Credit™
- 0.50 ANCC contact hours
- 0.50 Participation
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