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Oncology Pharmacy Consults:
Shifting Paradigms in the Treatment of Chronic Lymphocytic Leukemia

INTRODUCTION

Since the early 1990s, treatment of patients with chronic lymphocytic leukemia (CLL) has evolved from drug regimens based on alkylating agents, to regimens composed of the purine analog fludarabine combined with either the anti-CD20 monoclonal antibody rituximab alone, or rituximab and the alkylating agent cyclophosphamide. While these developments gave rise to increased remission duration, some mutations such as the deletions 11q and 17p remain predictive of significantly worse outcomes. Recently, 3 orally available targeted therapies, ibrutinib, venetoclax, and idelalisib have been approved for the treatment of patients with CLL and enable clinicians to treat patients with these mutations.

The development of new therapeutic approaches to CLL has necessitated an evolution of the role of the pharmacist. Pharmacists are well positioned to assist in the process of treatment selection based on risk factors and response monitoring. Moreover, since the targeted CLL therapies ibrutinib, venetoclax, and idelalisib are orally available, pharmacists are also well positioned to monitor adherence to therapy, as well in order to promote the safety of treatments by monitoring adverse events (AEs) and the potential for drug-drug interactions.


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