John Allan, MD

Articles

ASH 2025 Data Watch: Anticipated Developments for the CLL Treatment Landscape

August 20th 2025

Panelists discuss how CLL treatment has evolved from universal single-agent BTKi use to personalized approaches based on patient risk factors like IGHV mutation status and TP53 mutations, with growing excitement about fixed-duration oral doublet therapies combining BTKis with venetoclax that show promising efficacy despite lower MRD rates compared with antibody-containing regimens, while addressing the management of BTKi class effects through dose-modification strategies and multidisciplinary care coordination, and anticipating future developments including BTK degraders that show excellent efficacy with improved safety profiles in highly refractory populations, bispecific antibodies for fixed-duration approaches, and results from the CLL17 trial comparing oral doublets to venetoclax-obinutuzumab that may further establish the role of time-limited combination therapies in transforming the treatment landscape.

Coordinating CLL Care to Identify BTKi Intolerance and Manage Toxicities

August 20th 2025

Panelists discuss how CLL treatment has evolved from universal single-agent BTKi use to personalized approaches based on patient risk factors like IGHV mutation status and TP53 mutations, with growing excitement about fixed-duration oral doublet therapies combining BTKis with venetoclax that show promising efficacy despite lower MRD rates compared with antibody-containing regimens, while addressing the management of BTKi class effects through dose-modification strategies that have become preferred over drug switching, emphasizing that intolerance is subjectively defined by patient acceptance and requires a multidisciplinary team approach including extensive patient education, close monitoring by nurses and pharmacists, and collaboration with cardio-oncology specialists to manage cardiovascular toxicities, with the notable exception that ventricular arrhythmias like PVCs warrant immediate consideration for drug discontinuation due to risk of sudden death.

BTKi Dose Modification: Preserving Efficacy While Managing Toxicity in CLL Therapy

August 13th 2025

Panelists discuss how chronic lymphocytic leukemia treatment has evolved from universal single-agent BTKi use to personalized approaches based on patient risk factors like IGHV mutation status and TP53 mutations, with growing excitement about fixed-duration oral doublet therapies combining BTKis with venetoclax that show promising efficacy despite lower MRD rates compared with antibody-containing regimens, while addressing the management of BTKi class effects including cardiovascular events, hypertension, bleeding, diarrhea, and rash through dose-modification strategies that have become preferred over drug switching, particularly for ibrutinib, where robust long-term data support maintained efficacy with dose reductions from 420 mg to 280 mg daily, though similar dose reduction evidence is less established for second-generation BTKis like acalabrutinib and zanubrutinib.

Clinical Practice Insights: Comparing the Safety Profiles of Acalabrutinib, Ibrutinib, and Zanubrutinib

August 13th 2025

Panelists discuss how CLL treatment has evolved from universal single-agent BTKi use to personalized approaches based on patient risk factors like IGHV mutation status and TP53 mutations, with growing excitement about fixed-duration oral doublet therapies combining BTKis with venetoclax that show promising efficacy despite lower MRD rates compared with antibody-containing regimens, while addressing the management of BTKi class effects including cardiovascular events, hypertension, bleeding, diarrhea, and rash that typically occur early in treatment, noting that while second-generation BTKis may have slightly improved tolerability profiles compared with ibrutinib, most annoying adverse effects like arthralgias, cramps, and fatigue develop tachyphylaxis over time, with bleeding complications and late-onset dyskinesias being among the most challenging adverse events to manage across all BTKis.

Identifying BTKi Treatment-Related Adverse Events

August 6th 2025

Panelists discuss how CLL treatment has evolved from universal single-agent BTKi use to personalized approaches based on patient risk factors like IGHV mutation status and TP53 mutations, with growing excitement about fixed-duration oral doublet therapies combining BTKis with venetoclax that show promising efficacy despite lower MRD rates compared with antibody-containing regimens, while addressing the management of BTKi class effects including cardiovascular events, hypertension, bleeding, diarrhea, and rash that typically occur early in treatment but can sometimes develop later, with dose-reduction strategies being effective for maintaining efficacy while managing tolerability across first- and second-generation BTKis.

Expert Insights: Exploring Efficacy Differences in CLL MRD Rates Between the Fixed-Duration BTKi + BCL2i Regimens

August 6th 2025

Panelists discuss how CLL treatment has evolved from universal single-agent BTKi use to personalized approaches based on patient risk factors like IGHV mutation status and TP53 mutations, with growing excitement about fixed-duration oral doublet therapies combining BTKis with venetoclax that show promising efficacy despite lower MRD rates compared with antibody-containing regimens, while noting that ibrutinib-venetoclax combinations may still have advantages due to increased venetoclax exposure and deeper responses, particularly as the field moves toward time-limited therapies that reduce long-term toxicities and financial burden.

Identifying the Appropriate Patient With CLL for Continuous BTKi vs Fixed Duration BTKi + BCL-2i Regimens

July 30th 2025

Panelists discuss how treatment selection in CLL has evolved from universal single-agent BTKi use to a more personalized approach that considers patient-specific factors like IGHV mutation status, TP53 mutations, and 17p deletions, with growing excitement about emerging fixed-duration oral doublet therapies combining BTKis with BCL-2 inhibitors that may offer superior efficacy while reducing long-term toxicities and financial burden compared with continuous monotherapy approaches.

Clinical Perspectives: BTKi Treatment-Related Adverse Effects in Relapsed CLL

July 30th 2025

Panelists discuss how shared decision-making approaches in CLL treatment should balance BTKi selection with patient-specific risk features, particularly emphasizing the preference for BTKis over venetoclax-based therapy in high-risk patients with 17p deletion, while noting that approximately 20% of patients still receive outdated chemoimmunotherapy despite newer targeted treatments being available since 2016.

Emerging Developments for the Treatment of R/R CLL

July 1st 2025

Panelists discuss how emerging therapies including BTK degraders, bispecific antibodies, and novel BCL-2 inhibitors represent exciting future treatment options for managing CLL patients across different lines of therapy.

Bridging Strategies to CAR T Therapy: Perspectives on Incorporating BTK Inhibitors

June 24th 2025

Panelists discuss how bridging therapy with BTK inhibitors may optimize CAR T-cell outcomes by controlling bulky disease during manufacturing, with ibrutinib showing specific benefits for T-cell function enhancement.

Real-World Clinical Practice Insights from the TRANSCEND CLL004 Trial

June 24th 2025

Panelists discuss how lisocabtagene maraleucel (liso-cel) CAR T-cell therapy shows promise in heavily pretreated CLL patients, particularly younger patients with high-risk disease features who can achieve durable remissions.

Expert Insights on BRUIN CLL-321: Pirtobrutinib in Patients With BTKi Pretreated CLL

June 17th 2025

Panelists discuss how the positive BRUIN CLL-321 phase 3 trial results support pirtobrutinib use after covalent BTK inhibitor exposure and consider its role in second-line versus third-line treatment sequencing.

Clinical Approaches in Switching Between BTKi’s in R/R CLL & Practical Considerations for Drug Holidays

June 17th 2025

Panelists discuss how clinical trial data supports switching between different covalent BTK inhibitors for intolerance management, with 60-70% of patients experiencing resolution of the original toxicity.

Identifying BTKi Treatment Intolerance in R/R CLL

June 10th 2025

Panelists discuss how to define true BTK inhibitor intolerance versus manageable side effects and describe successful strategies for switching between covalent BTK inhibitors to maintain treatment efficacy.

Considerations with Retreatment of Venetoclax-Containing Regimens

June 10th 2025

Panelists discuss how retreatment with venetoclax may be appropriate in certain scenarios despite prior exposure, though continuous BTK inhibitor therapy is often preferred for patients with high-risk disease features.

Clinical Perspectives: 59yF with R/R CLL Experiencing BTKi Treatment-Related AE

June 3rd 2025

Panelists discuss how to manage BTK inhibitor-related adverse events including atrial fibrillation, bleeding, and gastrointestinal toxicities through dose modifications, supportive care, and potential drug switching strategies.

Expert Perspectives: Sequencing Strategies After Acalabrutinib + Venetoclax +/- Obinutuzumab as First-Line Therapy in CLL

June 3rd 2025

Panelists discuss how sequencing therapies becomes challenging when using combination regimens like acalabrutinib-venetoclax in frontline treatment, requiring careful consideration of retreatment strategies and resistance mutation testing.

Timing of Treatment Initiation in Relapsed CLL: Factoring in Prognostic and Patient Factors

May 27th 2025

Panelists discuss how they approach prognostic marker testing at relapse, the importance of ruling out Richter's transformation, and timing of treatment initiation based on disease characteristics and progression patterns.

Clinical Perspectives: 59yF with R/R CLL After Time-Limited Therapy

May 27th 2025

Panelists discuss how a patient with CLL with initially low-risk disease and mutated IGHV unexpectedly relapsed early after receiving venetoclax-obinutuzumab treatment with acquisition of high-risk features, presenting unique treatment challenges.

Unmet Needs and Future Directions in Care in CLL

March 8th 2023

Closing out their discussion on novel treatment strategies in CLL, expert hematologist-oncologists address unmet needs and future directions in care.

NEXT PAGE
PREVIOUS PAGE