The Fellow on Call: The Heme/Onc Podcast
Sep 23, 2026 · 22 min · 11 segments
This week we wrap up our two-part CLL update by turning to relapsed and refractory disease. We pick up with the 68-year-old man from Part 1, now a year out from frontline therapy and showing signs of…
Guys, we are shifting gears.
We talked about frontline CLL management last time, and this time we're talking about relapsed refractory CLL.
Listeners, remember last time we had a new diagnosis of a patient coming into the ER with a myriad of symptoms, namely concerning for B symptoms, newly noted to have a white count elevation to 100,000. hemoglobin of 8 and the platelet count in the 60s, and talked about how we approach this patient in the frontline setting.
Let's say we fast forward now a year, and unfortunately, the patient is showing signs of relapse.
I think my first question, Vivek, is what are signs and symptoms that you're looking for or laboratory abnormalities that you're looking for that could be a tip-off that patients are in fact relapsing?
I think it's really important to know in CLL that relapses are common, that there are treatments, though we hope, that some of these patients treated with things like abinituzumab venetoclax and now BTK venetoclax fixed duration options, that some of these patients will actually have durable remissions that will effectively be cures, what we saw in some FCR-treated patients in the past.
And so we're hoping that we have that That being said, what we expect is that these patients inevitably will relapse at some point.
And the key thing is you use the same criteria that you did at start of treatment of when to treat again.
If patients are asymptomatic, they don't have unexplained cytopenias, then there's no real reason that you need to treat that patient.
Time to next treatment is a very, very important concept when it comes to some of these indolent lymphomas and CLL.
So you just reset.
And when you see that patient, you say, hey, is there an indication to treat? And if not, let's just survey you.
We've just kind of reset you back to your regular baseline CLL.
It is common, though, that when they do have their CLL recur after initial treatment, that it is very likely that they will need treatment at some point in the next with several months to a few years, it's still important to still monitor that patient, counsel them, make sure they have an indication to treat before just jumping to treatment.
Guys, we are shifting gears.
We talked about frontline CLL management last time, and this time we're talking about relapsed refractory CLL.
Listeners, remember last time we had a new diagnosis of a patient coming into the ER with a myriad of symptoms, namely concerning for B symptoms, newly noted to have a white count elevation to 100,000. hemoglobin of 8 and the platelet count in the 60s, and talked about how we approach this patient in the frontline setting.
Let's say we fast forward now a year, and unfortunately, the patient is showing signs of relapse.
I think my first question, Vivek, is what are signs and symptoms that you're looking for or laboratory abnormalities that you're looking for that could be a tip-off that patients are in fact relapsing?
I think it's really important to know in CLL that relapses are common, that there are treatments, though we hope, that some of these patients treated with things like abinituzumab venetoclax and now BTK venetoclax fixed duration options, that some of these patients will actually have durable remissions that will effectively be cures, what we saw in some FCR-treated patients in the past.
And so we're hoping that we have that That being said, what we expect is that these patients inevitably will relapse at some point.
And the key thing is you use the same criteria that you did at start of treatment of when to treat again.
If patients are asymptomatic, they don't have unexplained cytopenias, then there's no real reason that you need to treat that patient.
Time to next treatment is a very, very important concept when it comes to some of these indolent lymphomas and CLL.
So you just reset.
And when you see that patient, you say, hey, is there an indication to treat? And if not, let's just survey you.
We've just kind of reset you back to your regular baseline CLL.
It is common, though, that when they do have their CLL recur after initial treatment, that it is very likely that they will need treatment at some point in the next with several months to a few years, it's still important to still monitor that patient, counsel them, make sure they have an indication to treat before just jumping to treatment.
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