Dr. Shadman on Treatment Considerations in CLL

Mazyar Shadman, MD, a physician and associate professor in the Divisions of Medical Oncology and Clinical Research at Seattle Cancer Care Alliance, shares treatment considerations for patients with chronic lymphocytic leukemia (CLL).

When forming a treatment strategy, it is important to consider comorbidities, social and supportive factors, and disease characteristics, Shadman explains. Moreover, factors such as Functional Independence Score in Hemophilia and IDH mutational status, should also be taken into account.

The majority of patients will receive a BTK inhibitor or a venetoclax (Venclexta)-based regimen. However, there is a small patient population who can benefit from chemoimmunotherapy, which has been a focus of discussion in the field, Shadman says. The fludarabine, cyclophosphamide, and rituximab (Rituxan) regimen is not often utilized by Shadman, although he notes that occasionally a patient may be a good candidate for the approach, provided that they understand the risks. These risks include the possibility of developing acute myeloid leukemia or myelodysplastic syndrome.

For most patients, treatment with a BTK inhibitor or venetoclax is recommended, according to Shadman. However, fixed-duration therapy with venetoclax is appealing compared with continuous treatment with BTK inhibitors, Shadman concludes.