A recent viewpoint article published in Blood Advances offered updated guidance for managing chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL).

“The Lymphoma Research Foundation (LRF) convened a workshop comprising a panel of CLL/SLL experts in the United States to develop consensus recommendations for selection and sequencing of therapies for patients with CLL/SLL in the United States,” wrote Jacob Soumerai, MD, and colleagues. “Herein, the recommendations are compiled for use as a practical clinical guide for treating providers caring for patients with CLL/SLL.”

The panel opened with recommendations for treatment initiation, advising that the authors follow the International Workshop on CLL guidelines from 2018. They also shared the following assessments and their roles in treatment selection:

› Patient preference: The panel engages patients in treatment discussions in all settings, but especially in the first-line setting (deciding between a covalent BTK inhibitor and venetoclax-obinutuzumab) and the third-line setting (deciding between pirtobrutinib and liso-cel).

› Performance status & physical exams: The clinicians determine ECOG performance status before each line of therapy, perform complete physical examinations, and evaluate patients for lymphadenopathy and splenomegaly.

› Feasibility: Frequent visits to medical centers are required after ramping up venetoclax, and the treating facility must be able to perform STAT laboratory testing and appropriate interventions. For patients receiving liso-cel, the facility must be certified for CAR-T administration. Patients should be referred to LRF assistance programs to reduce financial burden.

› Comorbidities:Medical history, active comorbidities, and concomitant medications can in uence treatment selection in the front-line setting.

› Concomitant medications: Clinicians should carefully review medications before initiating a new therapy, as warfarin, nonwarfarin anticoagulants, and single or dual antiplatelet therapies can in uence treatment selection or require modification. Work with prescribers to find acceptable alternatives and consult with oncology pharmacists to determine whether concomitant medications will impact dosing

› Organ function: A comprehensive metabolic panel will reveal kidney and liver dysfunction, allowing clinicians to follow package inserts for appropriate dosing. The panel also noted that kidney dysfunction can increase the risk for tumor lysis syndrome.