ASH – CLL/SLLNews from ASH 2024: Treatment Updates, Improving QOL, and Novel Agents Comparable between long diameter (LDi) <5 cm (67%) and LDi ≥5 cm (63%).¹ ASH - CLL/SLLTreatment Combo Provides Consistently High PFS in Chronic Lymphocytic Leukemia (CLL), Small Lymphocytic Leukemia (SLL)5.5-year PFS rates: OS: 97% in both cohorts.¹ Assessed response per International Workshop on Chronic Lymphocytic Leukemia criteria, uMRD4 rates (<10–4 by flow cytometry), PFS, and OS in patient subgroups. First-line, fixed-duration ibrutinib plus venetoclax provides durable PFS and OS for patients with CLL or SLL.¹ Evaluated baseline lymph node (LN) size, depth of LN and MRD response, and outcomes. Conducted post hoc exploratory analyses based on maximum LN long diameter at baseline and end of treatment. Experienced shorter times to deterioration in specific symptoms (eg, bruising). CLL 12 study found ibrutinib improved global health/physical function.Assessing QOL and Treatment Impact in Asymptomatic Early-Stage CLL No significant differences in other ibrutinib-associated toxicities (eg, diarrhea, skin issues). Faster improvements in global health scores and physical functioning. Examined quality-of-life outcomes in treatment-naive, asymptomatic patients with early-stage chronic lymphocytic leukemia. Patients with ibrutinib: Physician’s Weekly spoke with Richard Newcomb, MD, on the role of nurses and APs in palliative care.Nurses & Aps Role in Enhancing Palliative Care for Patients With Blood Cancer Undergoing Transplant“I think if you go back to our specialty palliative care studies, the palliative care clinicians were either specialty palliative care physicians or nurse practitioners who are trained in palliative care,” explains Richard Newcomb, MD. “And so, in these domains, I think it’s critical to involve people outside the physician world. So I think bedside nurses could play a huge role in [palliative care education].”
“I think when you look at averages in terms of who is doing palliative care in the hospital, everybody’s quality of life on an average basis goes down during transplant just because it’s a hard process,” offers Dr. Newcomb. “But, receiving palliative care was mostly trying to prevent a very large decrement in quality of life or a very large increase in symptoms. And what was interesting is that there were people in the responder group that their quality of life got better throughout the transplant hospitalization.” Liso-cel shows durable efficacy in R/R CLL/SLL, with extended OS of 43.2 months.Treatment Sustains Clinical Benefit Over Two Years in relapsed or refractory chronic lymphocytic leukemia (R/R CLL), small lymphocytic lymphoma (SLL)Median OS: 43.2 months at a median follow-up of 23.8 months (range: 0.4–59.6).²Patients received 50 × 10⁶ dose level (DL) 1 or 100 × 10⁶ (DL2) CAR+ T cells after lymphodepleting chemotherapy.²Objective response rate: 44% at DL2. And complete response or complete response with incomplete marrow recovery: 20% at DL2.²Liso-cel demonstrated durable responses and extended OS in R/R CLL/SLL. Evaluated liso-cel in R/R CLL and SLL. Majority received R-CHOP-like regimens ASH - CLL/SLLChallenges in Treating Richter Transformation With Novel Agents 17% did not receive systemic therapy due to frailty Median progression-free survival (PFS): 5.8 months Median overall survival (OS): 9.8 months Patients receiving systemic therapy had better outcomes: Median OS: 13 months Two-year OS: 31% ASH 2024 study examined RT clinical features and outcomes in British Columbia across the Chemoimmunotherapy (CIT) era (pre-2016) and Novel agents (NA) era (post-2016). ASH - CLL/SLLReferences1. Wierda WG, Jacobs R, Barr PM, et al. Consistently high 5.5-year progression-free survival (PFS) rates in patients with and without bulky baseline lymphadenopathy ≥5 cm are associated with high undetectable minimal residual disease (uMRD4) rates after first-line treatment with fixed-duration ibrutinib + venetoclax for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) in the phase 2 CAPTIVATE study. Abstract #1869. Presented at the 66th American Society of Hematology Annual Meeting & Exposition; December 7-10, 2024; San Diego, California. 2. Siddiqi T, Gauthier J, Kenderian S, et al. Lisocabtagene maraleucel (liso-cel) in patients (pts) with relapsed or refractory (r/r) chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (sll): Updated follow-up of Transcend CLL 004. Presented at: 66th American Society of Hematology Annual Meeting; December 7-10, 2024; San Diego, California.
