Dr. Richard Furman Discusses the Treatment of CLL

Dr. Richard Furman, M.D.
Dr. Richard Furman, M.D.

Recently the director of the CLL Research Center at Weill Cornell Medicine, Dr. Richard Furman sat down with Targeted Oncology to discuss how he treats patients with CLL. Although he emphasized the importance of physician autonomy in the selection of treatments they should be willing to use the latest treatments approved by the FDA. Referring to venetoclax, which received FDA approval earlier this year for CLL patients with del 17p CLL he said,

“If you have a patient with CLL of any type and you believe venetoclax is best for [that patient], you absolutely should use it. There’s nothing about the specificity of the FDA approval that should prevent you. Insurance coverage may be another matter, but clinically speaking, you’re on solid ground.”

Additionally he noted the importance of progression free survival (PFS), which refers to the length of time during and after a treatment in which a disease has not gotten worse. He said,

“Hands down, PFS is the single most important thing to patients. As oncologists who must balance many clinical concerns, it can be easy for us to forget that fact.”

You can continue reading about Dr. Furman’s treatment options in the article.

Ask the Expert: The Difference Between CLL Stage and SLL Stage

Question

What is the difference between CLL stage (Rai or Binet) and SLL stage (Ann Arbor)? Why does the same disease have two different staging systems?

Answer

Dr. Richard Furman, M.D.
Dr. Richard Furman, M.D.

Dr. Richard Furman writes: The purpose of a staging system is to help clinicians better determine prognosis and plan treatment for a patient’s disease. Although chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are the same disease, they were not recognized as the same disease until 1994. Since then they have been combined into one entity, CLL/SLL.

For historical reasons, CLL was staged based upon the Rai or Binet scheme (see below) and SLL was staged using the Ann Arbor lymphoma staging scheme (see below). Today most CLL specialists use the Rai stage because it is more clinically helpful. Using the Ann Arbor classification to stage SLL is problematic in scenarios where the disease has spread to the bone marrow. A person with SLL in their lymph nodes and bone marrow would immediately be characterized as an Ann Arbor stage IV, but their prognosis and treatment plan would be far better indicated as measured by the Rai stage I. Therefore the Rai stage, even without lymphocytosis, provides better prognostic and therapeutic information for a physician to treat their patient.

Rai Stages

0: lymphocytosis (an increase in number of lymphocytes in the blood).

I: Lymphocytosis + lymphadenopathy, (enlarged lymph nodes).

II: Lymphocytosis + splenomegaly (enlargement of the spleen) +/- lymphadenopathy

III: Lymphocytosis + anemia (decrease in red blood cells) +/- splenomegaly +/- lymphadenopathy

IV: Lymphocytosis + thrombocytopenia (decrease in platelets) +/- anemia +/- splenomegaly +/- lymphadenopathy

Ann Arbor Stages

I: Disease found in one group of lymph node

II: Disease found in two or more groups of lymph nodes on the same side of the diaphragm.

III: Disease found in two or more groups lymph nodes on both sides of the diaphragm.

IV: Extranodal disease (found outside of the lymph nodes), including bone marrow, liver, or other organs)

Note: if only one isolated area or organ involvement is present, then it would be a stage I, except for bone marrow.

Ask the Doctor: Dr. Richard Furman on the Latest Treatment Options for CLL/SLL

DRFurman_5284
Dr. Richard Furman, MD

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are cancers that affect the lymphocytes in the immune system. Essentially the same disease they are differentiated by the location in the body where they occur. CLL is found in the bloodstream, bone marrow, and sometimes the lymph node and spleen of patients, while SLL occurs in the lymph nodes of patients.

On Wednesday, September 21st at 6pm Director of the CLL Research Center, Dr. Richard Furman will give a presentation on currently available treatment options for patients with CLL/SLL. The presentation will be followed by a Q&A session. This presentation is part of the Lymphoma Research Foundation’s (LRF) “Ask the Doctor” program designed specifically for people affected by lymphoma, and seeks to provide the latest information on treatment. Online registration is available here.

The program includes:

  • Overview and Treatment Options for Chronic Lymphocytic Leukemia / Small Lymphocytic Lymphoma – ( CLL / SLL )
  • Research Updates
  • Question and Answer Session

This program is free-of-charge and dinner will be provided. Pre-registration is required.

Three Easy Ways to Register!

Call: 800-500-9976
Email:  mspellman@lymphoma.org
Web: Click here