Nitin Jain, MD, assistant professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses the treatment of patients with chronic lymphocytic leukemia (CLL) who have developed Richter’s transformation.

Richter’s transformation remains an unmet medical need, says Jain. Most of the targeted therapies for CLL have not been successful in patients with Richter’s transformation.

Checkpoint blockade is a valid concept, Jain says, as well as chimeric antigen receptor (CAR) T-cell therapies—studies of which will come out in the next few years.

Videos

Nitin Jain, MD, assistant professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses the treatment of patients with chronic lymphocytic leukemia who have developed Richter’s transformation.

Dr. Jain Discusses Treatment of Richter's Transformation in CLL

Nitin Jain, MD, assistant professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses PD-1 expression in patients with chronic lymphocytic leukemia (CLL) who were treated with the combination of nivolumab (Opdivo) and ibrutinib (Imbruvica).

In the ongoing phase II trial, there were encouraging results of safety and activity. The overall response rate was 80% for patients with relapse/refractory CLL, and PD-1 expression on large cells appeared to predict greater activity in this cohort.

Prior research revealed increased expression of PD-1, PD-L1, and PD-L2 on CLL cells, which suggests that blocking these targets could aid in T-cell activation.

Dr. Jain on PD-1 Expression in Nivolumab/Ibrutinib Combination in CLL

Nitin Jain, MD, assistant professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses the efficacy and safety of the combination of idelalisib and rituximab for older patients with chronic lymphocytic leukemia.

In a trial at The University of Texas MD Anderson Cancer Center, patients over age 65 were treated with frontline idelalisib and rituximab. Significant efficacy was observed with the combination — 97% of patients responded.

After an average of 9 months after starting treatment, patients experienced colitis, including some grade 3 colitis (10/64).

Jain says there is activity with the combination, but that physicians need to be watchful of colitis in older patients.

Dr. Jain on the Combination of Idelalisib and Rituximab for Older Patients With CLL

Nitin Jain, MD, assistant professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses lymphocytosis following treatment with a B-cell receptor inhibitor for patients with chronic lymphocytic leukemia.

The initial pattern of response following treatment with a b-cell receptor inhibitor is rapid reduction in lymphadenopathy associated with increased lymphocytosis. When patients start idelalisib and this reaction occurs, a treating oncologist should not regard this as progression — it may take 6-9 months for the white blood cell count to normalize.

View more from the 2014 Chemotherapy Foundation Symposium

Nitin Jain, MD, assistant professor, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses lymphocytosis following treatment with a B-cell receptor inhibitor.

Nitin Jain, MD

Articles

Dr. Jain Discusses Treatment of Richter's Transformation in CLL

Dr. Jain on PD-1 Expression in Nivolumab/Ibrutinib Combination in CLL

Dr. Jain on the Combination of Idelalisib and Rituximab for Older Patients With CLL

Dr. Jain on Increased Lymphocytosis Following Treatment With a B-Cell Receptor Inhibitor