NCCN Updates Treatment Guideline for CLL

10/12/18

The National Comprehensive Cancer Network (NCCN) updated their guideline for chronic lymphocytic leukemia (CLL) to include key information on tumor lysis syndrome prophylaxis and treatment with duvelisib for disease with or without del(17p)/TP53 mutation.

In the section for tumor lysis syndrome, a bullet was removed: “Consider tumor lysis syndrome prophylaxis for patients at high risk for tumor lysis syndrome, including those with bulky disease and those with progressive disease after small-molecule inhibitor therapy.”

Under tumor lysis features, the guideline now reads “Consider tumor lysis syndrome prophylaxis for patients with the following risk factors.” The listed factors include patients receiving treatment with venetoclax chemoimmunotherapy, lenalidomide, and obinutuzumab; progressive disease after small-molecule inhibitor therapy; bulky lymph nodes; spontaneous tumor lysis syndrome; elevated white blood cell; pre-existing elevated uric acid; and renal disease or renal involvement by tumor.

For the treatment of tumor lysis syndrome, rasburicase was clarified by removing the risk factor “presence of any high-risk feature.”

A significant change was made to the section for suggested treatment regimens for relapsed or refractory CLL without del(17p)/TP53 mutation. For frail patients with significant comorbidity or aged at least 65 years, younger patients with significant comorbidity, and patients aged less than 65 years without significant comorbidity, duvelisib was added as a category 2A recommendation under the preferred regimens.

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For relapsed or refractory therapy for CLL with del(17p)/TP53 mutation, duvelisib was added as a category 2A recommendation under the preferred treatments.

In the section for special considerations for the use of small-molecule inhibitors, information regarding duvelisib was added.—Zachary Bessette