{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses","description":"\u201cMeasurable residual disease is where I think the terminology fits best in that, it is intended to measure the amount of cancer cells that are present in the blood or bone marrow at the time the sample was collected. We can identify one cancer cell in a million. Where that can be really valuable is when we start to think about the duration of treatments and the response to some of our treatments,\u201d ONS member Caitilin Murphy, DNP, APRN, FNP-BC, AOCNP\u00ae, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS\u00ae, TCTCN\u2122, oncology clinical specialist at ONS, during a conversation about chronic lymphocytic leukemia (CLL) treatment considerations for oncology nurses. Music Credit: \u201cFireflies and Stardust\u201d by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD), including 45 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by August 14, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center\u2019s Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to treatment of chronic lymphocytic leukemia. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast\u2122 episodes: Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses Episode 256: Cancer Symptom Management Basics: Hematologic Complications Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis Episode 184: Oncologic Emergencies 101: Tumor Lysis Syndrome ONS Voice articles: Fixed-Duration Therapy for CLL May Lower Cardiovascular Risks and Costs Less Than Continuous Treatment Individuals With CLL Face Increased Risk for Skin Cancer Master Hypersensitivity Reactions With These Strategies for Prevention and Management Patients With CLL Report Worse QoL and Other Factors Clinical Journal of Oncology Nursing articles:  Acalabrutinib: Nursing Considerations for Use in Patients With Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma Pseudohyperkalemia in Chronic Lymphocytic Leukemia: An Often Overlooked Clinical Entity Richter Transformation Arising From Chronic Lymphocytic Leukemia Venetoclax: Management and Care for Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia ONS book: Site-Specific Cancer Series: Leukemia (first edition) ONS symptom management resources:  Fatigue Prevention of Bleeding Prevention of Infection: General Blood Cancer United: Chronic Lymphocytic Leukemia Treatment CLL Society: Patient Education Toolkit Lymphoma Research Foundation: Lymphoma Treatments Patient education sheets Acalabrutinib Ibrutinib Pirtobrutinib To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode \u201cBlood work is a really nice way to evaluate if there is progression of the disease. And we evaluate their blood counts, specifically that complete blood count with a differential. We anticipate an elevated white count, and we anticipate that the absolute lymphocyte count is going to be elevated. That\u2019s characteristic of the disease. But what evolves and happens is that those numbers can rapidly change and what we get concerned about is if that white count\u2014and the percentage of the absolute lymphocyte count specifically\u2014starts to increase and double quickly.\u201d TS 5:52 \u201cThere are some components that help clinicians decide if we expect these things, this cadence of change to happen more readily, or if we feel really comfortable that the biology of the variants contributing to the type of CLL that each patient may have, they may not have that progression as quickly or at all. And so that kind of helps us in that follow-up and cadence. Oftentimes, we\u2019re checking blood work every three or six months. Some patients are on an annual interval of visits depending on that active surveillance. I think the other piece is that we have a relatively low threshold when there is a change in symptoms to just recheck those blood tests. It\u2019s nice that we can have a pretty readily available blood test to be able to give us a lot of information for these patients.\u201d TS 9:45 \u201cWhen we think about CLL therapy, the old tried and true [treatments] still work: so, rituximab and obinutuzumab. And then we kind of start to think about pathways and the way, the mechanisms of which these treatments are integrated. We think about different pathways of how we can induce cell death, but also what are the potential side effects? What are the potential interactions?\u201d TS 19:35 \u201cI think a lot of this is about really having a clear understanding of the patient\u2019s goals and really being able to understand and align. I think we have a lot more data to provide guidance for those patients that really are wanting to know: What is my chance of overall survival? If I do this, does this mean that I don\u2019t need to ever be on treatment again? If I do it this way, does it mean that I have to come into clinic every week, or does it mean that I have to come in every week but I\u2019m done? I do one year of treatment, and I don\u2019t have to think about treatment for a really long time based on some of these components that we can take into consideration.\u201d TS 24:36 \u201cWhen we think about the B-cell lymphoma 2 (BCL-2) inhibitors, with venetoclax, I think the biggest component we think about is tumor lysis syndrome. It\u2019s so effective that these cancer cells release all of those electrolytes, potassium, phosphorus; you can see a rise in the lactate dehydrogenase and uric acid because those cells are breaking down. And so subsequently, that leads us to the consideration of, is the patient\u2019s kidney function able to clear it? And so a lot of frequent lab monitoring, a lot of hydration, supportive care with medications like ursodiol or allopurinol to really improve the ability to clear that cellular waste product so that it doesn\u2019t cause an oncologic emergency.\u201d TS 34:11 ","author_name":"The ONS Podcast","author_url":"http:\/\/onsvoice.libsyn.com\/website","html":"