Overview of the Updated NCCN Guidelines on Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

Deborah Stephens, DO, Huntsman Cancer Institute, University of Utah, and member of the NCCN Guidelines Panel for the Management of CLL, provides an overview of the latest updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for chronic lymphocytic leukemia/small lymphocytic lymphoma.

Deborah Stephens, DO: Hi, my name is Deborah Stephens and I'm the Director of the CLL program at the Huntsman Cancer Institute at University of Utah, and a member of the NCCN Guidelines Panel for the Management of CLL. I recently gave an update of the NCCN Guidelines for patients with CLL at the annual NCCN Conference.

Can you briefly provide an overview of the latest NCCN Guidelines updates for treating patients with chronic lymphocytic leukemia?

Dr Stephens: The NCCN Guidelines Panel for CLL is now organized into four main groups, frontline and subsequent treatments for both patients with and without high-risk features of deletion 17p or TP53 mutation. And for subsequent treatment options, really the critical decision points are based on what therapy or therapies the patient had received previously. In all of these categories, the preferred therapies are actually targeted therapies, including the Bruton tyrosine kinase inhibitors acalabrutinib and zanubrutinib, and the BCL2 inhibitor venetoclax, which is paired with anti-CD20 monoclonal antibodies such as rituximab or obinutuzumab.

In the last year, the Bruton tyrosine kinase inhibitor ibrutinib was moved to the other recommended from the preferred category. And this was really based on the results of two large Phase 3 studies, the ELEVATE-RR and the ALPINE study, which compared acalabrutinib or zanubrutinib head-to-head with ibrutinib in patients with relapsed and refractory CLL. And in these trials, acalabrutinib and zanubrutinib either demonstrated equal or better efficacy for these patients with CLL and less toxicity. And so this is why the guidelines shifted to recommend these second generation BTK inhibitors over ibrutinib. But really in reality, there are a lot of highly effective therapies for CLL, and these guidelines will continue to be refined in the coming years as new drugs are developed.