The Role of the Pharmacist in CLL
High-Risk CLL is known for the challenge as patients don’t respond well to many treatments, although this scenario is improving with the introduction of new treatment options and the study of different combinations of new agents and different sequences of treatment.
Richter’s Transformation (RT) is a high-risk aggressive form of CLL described by pathologist Dr. Maurice Richter in 1928 as a rapidly progressing disease characterized by lymphadenopathy (enlargement of lymph nodes), splenomegaly (enlargement of spleen), bone marrow involvement and lymphocytocis (high lymphocyte count). It occurs in 5-10% of CLL patients and the challenge is that there is currently no standard treatment.
At the April 2015 Patient Education and Empowerment meeting held in conjunction with the CLL Research Consortium meeting at UCSD in San Diego, Dr. Januario Castro described a clinical trial that he, Dr. Thomas Kipps and Dr. Michael Choi developed to address the need for effective treatments for Richter’s Transformation. He shares with the audience a slide showing a tissue sample that provides a clear illustration of the difference between the small homogeneous cells of CLL and the larger more aggressive-looking darker cells of RT.
Kipps, Castro and Choi have developed a trial to study non-chemotherapy treatment of RT combining obinutuzumab, high-dose methylprednisolone (HDMP) with lenalidomide. For those patients who are eligible, there is a consolidation phase leading to an allogeneic hematopoietic stem cell transplant. For those who have comorbidities, are of advanced age, or are otherwise ineligible, they would transition to maintenance treatment with lenalidomide.
Take a look at this video of Dr. Castro’s presentation here.
Betsy Dennison, RN 11/16/15
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