CLL Workshop Emphasizes Engaging Conversations on Shared Treatment Planning

Deborah Stephens, DO, and Jacob D. Soumerai, MD, spoke with CancerNetwork^® about key talking points that resonated with them during a Lymphoma Research Foundation workshop on selecting and sequencing therapies for patients with chronic lymphocytic leukemia (CLL).

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, noted the workshop’s discussion on how features such as minimal residual disease may inform clinical practice. For example, although using BTK inhibitor resistance mutations as a guiding factor for therapeutic strategies is not quite ready for mainstream practice, Stephens stated that ongoing trials aim to assess how this marker may be applicable in the clinic.

Additionally, Soumerai, a clinical investigator in Lymphoma and assistant professor in Medicine at Massachusetts General Hospital, emphasized the workshop’s point of engaging patients and involving them in a shared discussion about treatment decisions. He detailed how clinicians and patients alike should have as much information as possible to empower both parties to optimally select subsequent therapy.

Transcript:

Stephens: This was a nice group of physicians from across the country that all agreed to work with the Lymphoma Research Foundation to come up with some practical guidelines. It was a great collaborative group. We spent a lot of time workshopping and trying to get complete agreement and consensus between all of the experts. It was a great group, and there were a couple of key pieces that I felt still took a lot of discussion, and there was not a clear consensus on it. That is the use of minimal residual disease and how to use it in clinic. Should we be guiding therapy by it? Another piece was, should we be using BTK resistance mutations in clinical practice? Since there is not a consensus, we decided that it’s not quite ready for mainstream [practice], but there is a lot of clinical trials ongoing that hope to help address how to best use this in clinical practice.

Soumerai: For most patients with CLL, the primary decision-making is that choice of initial therapy. One thing that really resonated for me was the fact that we have so many factors that drive the decision-making. But at the end of the day, probably for a majority of patients, there are multiple reasonable treatment approaches. One of the key things is the importance of engaging patients. There are some interesting data that we cited in that, clearly, most patients want to participate in these discussions. [They] want to be engaged in a shared decision-making discussion regarding their treatment decisions, yet less than half of patients actually report having this opportunity.

This effort is attempting to both provide the clinicians with all of the data that we use in making these treatment decisions but also trying to empower patients to come to these discussions with as much information as possible so that they can also participate in these decisions regarding their treatment selection.

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.