Navigating Treatment Decision-Making Challenges in CLL Management

In a conversation with CancerNetwork®, Deborah Stephens, DO, and Jacob D. Soumerai, MD, spoke about current challenges in the management of chronic lymphocytic leukemia (CLL), particularly those that to relate to the treatment decision-making process. They discussed these obstacles in the context of a CLL working group organized by the Lymphoma Research Foundation, which convened to generate consensus recommendations for selecting and sequencing anti-cancer therapies for CLL in the US. Consensus recommendations from this group were published in Blood Advances in November 2024.

According to Stephens, an associate professor of Medicine, director of the CLL and Richter’s Program, and physician leader of the CLL and Lymphoma Research Program at the University of North Carolina School of Medicine, there is not a single treatment modality that patients can receive on its own to cure their disease. As a result, clinicians must figure out how to optimally select frontline regimens to set the foundation for subsequent therapies in the second- and third-line settings.

Soumerai, a clinical investigator in Lymphoma and assistant professor in Medicine at Massachusetts General Hospital, stated that the difficulty of recognizing subtle differences between available treatment options served as the foundation for the CLL working group. He described how the workshop aimed to address this complexity by giving clinicians the resources to adequately select one treatment approach over another while making informed decisions regarding subsequent care.

Transcript:

Stephens: There is a lot of great things that are happening for physicians in the management of CLL just because there are a lot of good targeted treatments that are available. A lot of challenges result around trying to figure out how to sequence the therapy and pick the best treatment that comes first in line so we can still [treat] the patients in the second or third line. A part of that comes because the challenge is we do not have a cure for CLL yet. We are talking about sequencing treatments because there is not one treatment that the patients can receive and then be completed.

Another challenge I would say that faces clinicians is [that] unlike a lot of other lymphoid malignancies, CAR T and transplant have been successful in helping patients, whereas with CLL, there’s a lot of morbidity associated with it. Due to the age of patients, it’s hard to get patients well enough and in remission [to be] in a good spot to go to transplant or CAR T. Those are some of the main features that are affecting physicians right now.

Soumerai: We are in a space where there are so many options that one of the most difficult things about [treating] patients with CLL is, frankly, keeping up with the subtle differences in some of these therapies and the effects on the patients we are caring for. That has served as the foundation for the [CLL working group]. How do we meet that problem by giving clinicians all the information about the differences in these treatments, the differences in patients that help guide whether we should be recommending one treatment approach vs another and [making] all the different decisions that spiral after that initial treatment decision is made?

Reference

Soumerai JD, Barrientos J, Ahn I, et al. Consensus recommendations from the 2024 Lymphoma Research Foundation workshop on treatment selection and sequencing in CLL or SLL. Blood Adv. 2024;19:bloodadvances.2024014474. doi:10.1182/bloodadvances.2024014474.