Nicole Lamanna, MD, Associate Professor of Clinical Medicine, Columbia University Medical Center, discusses incorporating novel therapies into the standard treatment paradigm for patients with chronic lymphocytic leukemia (CLL).

The approvals of ibrutinib and idelalisib have changed the outlook for patients with CLL significantly, said Lamanna. The challenge now is determining if and how to combine these new agents with the traditional therapies used in CLL.

For younger patients, these agents may work best when combined with cytotoxics, but toxicities must be considered, said Lamanna. For older patients in their 70s or 80s, chemotherapy may not be necessary. Novel agents like ibrutinib and idelalisib may be enough on their own for patients with a shorter expected lifespan.

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Nicole Lamanna, MD, Associate Professor of Clinical Medicine, Columbia University Medical Center, discusses incorporating novel therapies into the standard treatment paradigm for patients with chronic lymphocytic leukemia (CLL).


Dr. Lamanna on Incorporating Novel and Traditional Therapies in CLL 

Nicole Lamanna, MD, clinical professor of medicine, Columbia University Medical Center, discusses lymphocytosis following treatment with new oral CLL agents.

Lamanna says regular IV chemotherapy would knock down patients' blood count. Once a patient is treated with new oral agents, such as ibrutinib, the lymph nodes shrink, causing the blood count to rise. This caused some alarm in early clinical trials because researchers thought patients were progressing, Lamanna says.

Lamanna says over time, usually in a matter of months, the lymphocytosis resolves and gets better. 

Nicole Lamanna, MD, clinical professor of medicine, Columbia University Medical Center, discusses lymphocytosis following treatment with new, oral CLL agents.

Nicole Lamanna, MD

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Dr. Lamanna on Incorporating Novel and Traditional Therapies in CLL

Dr. Lamanna Discusses Lymphocytosis Following CLL Treatment