Jeffrey Jones, MD, MPH, assistant professor of Internal Medicine, Division of Hematology, Department of Internal Medicine, Ohio State University Wexner Medical Center, discusses NCCN recommendations for treatment of relapsed patients with chronic lymphocytic leukemia (CLL).

The remarkable change to the guideline over the last several years, according to Jones, is the adoption of small-molecule inhibitors of B-cell receptor signaling. These include ibrutinib (Imbruvica) and idelalsib (Zydelig). Both agents are accepted as the first best alternative choice for treating relapsed disease, regardless of age, comorbidities, and other factors.

These agents appear to be safe and well-tolerated, and provide a better treatment choice in the relapsed setting compared with chemotherapy, Jones adds.

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Dr. Jeffrey Jones on NCCN Recommendations for Relapsed Patients With CLL

Jeffrey Jones, MD, MPH, Assistant Professor of Internal Medicine and section head of the Chronic Lymphocytic Leukemia (CLL) research program at Ohio State University, discusses idelalisib (Zydelig) combinations in CLL.

Although idealisib has been proven effective as a single-agent therapy, sustained remissions that eventually lead to the discontinuation of therapy may require combination therapies, says Jones.

Idealisib has been studied in combination with monoclonal antibodies, chemotherapy, and most recently novel targeted therapies like ofatumumab (Arzerra). Ofatumumab was shown to improve progression-free survival by 8 months in combination with idealisib compared to ofatumumab alone in a phase III randomized, controlled study.

Dr. Jeffrey Jones on Idelalisib Combinations in CLL 

Jeffrey Jones, MD, MPH, Assistant Professor of Internal Medicine and section head of the Chronic Lymphocytic Leukemia (CLL) research program at Ohio State University, discusses the results of a phase III randomized, controlled study evaluating idelalisib (Zydelig) in combination with ofatumumab (Arzerra) compared to ofatumumab alone for previously treated CLL.

The number of agents that have traditionally been available for patients with relapsed or refractory CLL has been limited, says Jones. Patients in this study received 6 months of ofatumumab in both arms, and patients in the combination arm received twice-daily idelalisib to be continued until disease progression or intolerable side effects.

Progression-free survival was significantly improved in the combination arm, with a median progression-free survival of just over 16 months, compared to 8 months in the ofatumumab-only arm, says Jones. The overall response rate was 75% in the combination arm versus 18% in the single agent arm.

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Jeffrey Jones, MD

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Dr. Jeffrey Jones on NCCN Recommendations for Relapsed Patients With CLL

Dr. Jeffrey Jones on Idelalisib Combinations in CLL

Dr. Jeffrey Jones on Efficacy of Idelalisib/Ofatumumab Combination in CLL