Updates in the Management of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: Sequencing Therapy and the Role of MRD Testing
The therapeutic landscape of chronic lymphocytic leukemia (CLL) has evolved significantly in recent years and the use of targeted therapies in the first-line setting will significantly alter the management of relapsed/refractory disease. In addition to the several factors related to patient (age, performance status and comorbid conditions) and disease (clinical stage, cytogenetic or molecular characteristics), the nature of the prior first-line therapy and the duration of remission to that therapy are the key considerations for the selection of treatment for patients with previously treated CLL/SLL. The measurement of minimal residual disease (MRD) is emerging as an important tool to assess treatment efficacy and determine the duration of treatment based on the nature of therapeutic agent used. There is a continuing need to educate hematologists and oncologists about the challenges and special considerations involved in the management of patients with CLL/SLL so that they can make informed clinical decisions and develop an individualized treatment plan for their patients.
This information was originally presented at the NCCN 2020 Virtual Congress: Hematologic Malignancies™ held on October 9-10, 2020.
This educational program is designed to meet the educational needs of oncologists, hematologists, nurse practitioners, nurses, pharmacists, physician assistants, and other health care professionals who manage patients with hematologic malignancies.
Following this program, participants should be able to:
- Review the treatment options for patients with newly-diagnosed chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and identify patients who could be candidates for chemoimmunotherapy.
- Assess available evidence on sequencing therapy for patients with relapsed/refractory disease and develop an individualized treatment plan based on prior first-line therapy and other disease-specific as well as patient-specific characteristics.
- Describe the role of minimal residual disease (MRD) assessment and its implications on the management of patients with CLL/SLL.
William G. Wierda, MD, PhD
The University of Texas MD Anderson Cancer Center
NCCN Medical Education Disclosure Policy
It is the policy of NCCN that every 12 months, all faculty, moderators, activity planners and all internal planning staff participating in NCCN continuing education activities are expected to disclose any financial relationships with a commercial interest as defined by the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support. In addition, all faculty presentations have been reviewed for adherence to the ACCME’s Standards for Commercial Support (the provider develops activities/educational interventions independent of commercial interests [SCS 1, 2 and 6] by experts on the topics).
Per the ACCME Standards for Commercial Support, individuals who do not disclose relevant financial relationships will be disqualified from involvement in the CE activity as a content developer, planner, or presenter. A complete list of individuals’ relationships with external entities is available upon request.
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 the following relevant financial relationships:
William G. Wierda, MD, PhD
AbbVie, Inc.: Grant/Research Support
AstraZeneca Pharmaceuticals LP/Acerta Pharma: Grant/Research Support
Celgene Corporation/Juno Therapeutics, Inc.: Grant/Research Support
Cyclacel Pharmaceuticals, Inc.: Grant/Research Support
Genentech, Inc.: Grant/Research Support
Gilead Sciences, Inc.: Grant/Research Support
GlaxoSmithKline/Novartis Pharmaceuticals Corporation: Grant/Research Support
Janssen Pharmaceutica Products, LP: Grant/Research Support
Kite Pharma: Grant/Research Support
Loxo Oncology, Inc.: Grant/Research Support
Oncternal Therapeutics, Inc.: Grant/Research Support
Pharmacylics: Grant/Research Support
Sunesis Pharmaceuticals, Inc.: Grant/Research Support
Xencor, Inc.: Grant/Research Support
NCCN Staff Disclosures
The NCCN Activity Planning staff listed below discloses no relevant financial relationships:
Michael Abrams; Melissa Esplen; Mark A. Geisler; Kristina M. Gregory, RN, MSN, OCN; Kristin Kline Hasson; Rose Joyce; Karen Kanefield; Lisa Perfidio, MS; Shannon Ryan, CMP; Kathy Ann Smith, CHCP; Sarah Weinstein
The NCCN Leadership listed below discloses no relevant financial relationships:
Robert W. Carlson, MD; Gary J. Weyhmuller, MBA, SPHR
The NCCN Leadership listed below discloses the following relevant financial relationships:
Wui-Jin Koh, MD: IBM Watson Health for Oncology and Genomics; Scientific Advisor
The NCCN Clinical staff listed below discloses no relevant financial relationships:
Mary A. Dwyer, MS, CGC; Hema Sundar, PhD
In support of improving patient care, National Comprehensive Cancer Network (NCCN) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
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.
NCCN designates this educational activity for a maximum of 0.50 contact hour.
NCCN designates this knowledge-based continuing education activity for 0.50 contact hour (0.05 CEUs) of continuing education credit. UAN: JA4008196-0000-20-146-H01-P
NCCN has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.50 AAPA Category 1 CME credit. Approval is valid until October 30, 2021. PAs should only claim credit commensurate with the extent of their participation.
- 0.50 AAPA Category 1 CME credit
- 0.50 ACPE contact hours
- 0.50 AMA PRA Category 1 Credit™
- 0.50 ANCC contact hours
- 0.50 Participation
To complete this activity, users will need:
- A device with an Internet connection
- One of the two latest versions of Google Chrome, Mozilla Firefox, or Safari (Internet Explorer is no longer supported)
- Adobe Flash Player and/or an HTML5 capable browser for video or audio playback
- Adobe Reader or other PDF reader software for certificate viewing/printing