An elderly woman with chronic lymphocytic leukemia (CLL)
CASE 1: A 78-year-old woman with multiple comorbidities and significant hip and back pain was diagnosed with CLL with lymphocytosis and mild cytopenias in 2009 and was observed without active therapy. In 2014, she presented with persistently worsening cytopenias and splenomegaly and received 6 cycles of obinutuzumab/chlorambucil. Currently she is being observed off therapy. Recently she sold her house and moved to an assisted living facility. (Ms Goodrich)

DISCUSSION TOPICS:

• Incidence of various cytogenetic abnormalities (13q and 17p deletions, et cetera) and their clinical implications
• Initial treatment selection for younger and older patients with standard- and high-risk CLL
• Available efficacy and safety data with obinutuzumab/chlorambucil in CLL; ongoing evaluation of obinutuzumab with other therapeutic partners
• Incorporating the small-molecule inhibitors ibrutinib and idelalisib into the treatment algorithm
• Novel agents and strategies under development (eg, venetoclax, CAR-T-cell therapy)

An elderly man with mantle-cell lymphoma (MCL) who received multiple treatments for relapsed disease
CASE 2: A 78-year-old man was diagnosed with MCL in 2005 and achieved a complete remission with R-CHOP x 8. He experienced relapse in 2009 and required a thoracentesis prior to lenalidomide (len)/rituximab x 6 and maintenance len on a clinical trial. After completing 60 cycles of len maintenance, he was switched to ibrutinib/rituximab. (Mr Lai)

DISCUSSION TOPICS:

• Front-line and maintenance treatment options for older and younger patients
• Recent FDA approval of bortezomib as a component (VR-CAP) of front-line treatment for patients with newly diagnosed MCL
• Available research data with and ongoing evaluation of the “R-squared” regimen (len/rituximab)
• Approach to relapsed or refractory (R/R) disease: Risks, benefits and sequencing of bortezomib, ibrutinib and len
• Cardiac toxicity and other side effects associated with ibrutinib

A 39-year-old father of 4 with follicular lymphoma (FL) treated with bendamustine/rituximab (BR) and rituximab maintenance
CASE 3: A 39-year-old father of 4 children was diagnosed with bulky Stage IIIA FL with abdominal discomfort in 2010. Because of the need to continue working, he received rituximab monotherapy x 4 weeks, with significant symptom improvement. In 2014, he experienced slow disease progression and achieved a PET-negative complete remission after BR x 6. He continues to work while receiving maintenance rituximab. The patient has had a strained relationship with his wife. (Ms Goodrich)

DISCUSSION TOPICS:

• Commonly used induction regimens for older and younger patients receiving active treatment for FL
• Potential benefits and ongoing development of rapid-infusion bendamustine
• Recent FDA approval of idelalisib: Mechanism of action and indications for use in relapsed FL
• Implementation of REMS (Risk Evaluation and Mitigation Strategy) program to manage toxicities associated with idelalisib

A 34-year-old woman with Hodgkin lymphoma (HL) who received multiple treatments for relapsed disease
CASE 4: A 34-year-old teacher was diagnosed with Stage IIB HL in November 2010 and received ABVD x 6 followed by involved-field radiation therapy to a mediastinal mass. She developed disease relapse but achieved a complete response to brentuximab vedotin (BV) and subsequently underwent autologous stem cell transplant. Five months later, she experienced disease progression and received BV x 16 cycles with infectious complications. She is currently receiving gemcitabine-based chemotherapy and is being considered for a clinical trial of an anti-PD-1 antibody. She continues to work and has a strong will to survive but profoundly dislikes coming to the oncology clinic. (Mr Lai)

DISCUSSION TOPICS:

• Key biologic differences between HL and NHL
• Selection and subsequent sequencing of therapies for patients with newly diagnosed HL
• Integration of BV in R/R HL; emerging role in post-transplant consolidation and other clinical settings
• Incidence and management of neuropathy, pancreatitis, neutropenia and other toxicities associated with BV in HL
• Emerging role of anti-PD-1 antibodies for patients with refractory HL and other hematologic cancers

An 83-year-old Catholic nun with diffuse large B-cell lymphoma (DLBCL) with CNS involvement
CASE 5: An 83-year-old Catholic nun with Stage IIA DLBCL achieved a complete remission on mini-R-CHOP. In July 2014, she presented with pronounced neurological changes, and a frontal mass was diagnosed as large B-cell lymphoma. She declined whole brain radiation therapy and received rituximab/temozolomide but experienced disease progression after 2 cycles with increasing neurologic decline. She transitioned from independent living to a nursing home, where hospice care was initiated prior to death. (Ms Goodrich)

DISCUSSION TOPICS:

• Current clinical management algorithm for patients with newly diagnosed DLBCL
• Ongoing evaluation and nonresearch role of novel agents (eg, len, ibrutinib, et cetera) in R/R disease
• Incidence, clinical manifestation and treatment of CNS lymphoma
• Indications for CD30 testing in B-cell NHL and role of BV

An elderly man with peripheral T-cell lymphoma (PTCL) treated with multiple standard and investigational agents
CASE 6: A 78-year-old Chinese man was diagnosed with Stage IIIA PTCL in 2008 and received CHOP x 3/CEOP x 3. Clinical trial opportunities are limited by decreased cardiac function. He has received multiple agents on and off protocol, including pralatrexate and romidepsin. He experienced a “spontaneous resolution” of his disease after interrupting treatment with pralatrexate for a vacation in China, although he denied use of complementary therapy. Currently, he is enrolled on a clinical trial of single-agent vorinostat. His treatments impose an important financial burden on his very supportive adult children. (Mr Lai)

DISCUSSION TOPICS:

• Key clinical differences between B-cell and T-cell lymphomas
• Optimal selection and sequencing of romidepsin, pralatrexate, belinostat and other systemic agents/regimens for patients with R/R PTCL
• Counseling patients about and managing romidepsin-, pralatrexate- and belinostat-related side effects
• Current role of BV for patients with T-cell lymphomas

Target Audience
This activity has been designed to meet the educational needs of oncology nurses, nurse practitioners and clinical nurse specialists involved in the treatment of HL and NHL.

Learning Objectives and Goals

• Provide patient-focused education to enhance clinical decision-making regarding the available systemic agents used in the management of indolent and aggressive forms of B-cell NHL, T-cell lymphomas and HL.
• Formulate supportive care strategies to manage the side effects associated with commonly employed therapeutic interventions for patients with NHL and HL.
• Evaluate preliminary safety data and reported outcomes with investigational agents and strategies, and counsel appropriately selected patients about the potential for enrollment in clinical trials.
• Identify opportunities to enhance the collaborative role of oncology nurses in the comprehensive biopsychosocial care of patients with lymphoma and CLL to optimize clinical and quality-of-life outcomes.

Accreditation Statements
This educational activity for 2 contact hours is provided by Research To Practice.

Research To Practice is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

To obtain a certificate of completion and receive credit for this event, attendees must sign in at the registration desk upon arrival, attend the entire activity and return a completed Educational Assessment and Credit Form upon exiting the activity. Your certificate will be mailed to you within 4 to 6 weeks. International clinicians, please note: In order for a certificate of completion to be issued, you must provide a valid email address.

Unlabeled/Unapproved Uses Notice
There is no implied or real endorsement of any product by Research To Practice or the American Nurses Credentialing Center. Any off-label use as declared by the FDA will be identified.

Content Validation and Disclosures
Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CNE activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — Ms Goodrich has no real or apparent conflicts of interest to disclose. The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process: Dr Flowers — Consulting Agreements: Celgene Corporation, OptumRx Inc, Seattle Genetics, Spectrum Pharmaceuticals Inc; Contracted Research: Acerta Pharma, Celgene Corporation, Gilead Sciences Inc, Infinity Pharmaceuticals Inc, Janssen Biotech Inc, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics Inc, Takeda Oncology; Unpaid Consulting Agreements: Genentech BioOncology, Takeda Oncology. Dr Horwitz — Consulting Agreements: Amgen Inc, Bristol-Myers Squibb Company, Celgene Corporation, Genzyme Corporation, Kyowa Hakko Kirin Co Ltd, Seattle Genetics, Spectrum Pharmaceuticals Inc, Takeda Oncology; Contracted Research: Celgene Corporation, Infinity Pharmaceuticals Inc, Kyowa Hakko Kirin Co Ltd, Pharmacyclics Inc, Seattle Genetics, Spectrum Pharmaceuticals Inc, Takeda Oncology. Mr Lai — Advisory Committee: Seattle Genetics. Dr Martin — Consulting Agreements: Bayer HealthCare Pharmaceuticals, Celgene Corporation, Genentech BioOncology, Idera Pharmaceuticals Inc, Novartis Pharmaceuticals Corporation; Speakers Bureau: Genentech BioOncology.

MODERATOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: AbbVie Inc, Amgen Inc, Astellas Scientific and Medical Affairs Inc, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Janssen Biotech Inc, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Myriad Genetic Laboratories Inc, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Teva Oncology, Tokai Pharmaceuticals Inc and VisionGate Inc.

Research To Practice staff and external reviewers — The scientific staff, planners, managers and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

This activity is supported by educational grants from Celgene Corporation, Genentech BioOncology, Janssen Biotech Inc, Pharmacyclics Inc, Seattle Genetics, Takeda Oncology and Teva Oncology.

If seats become available for the program, we will accept standby registrations on a first come, first served basis prioritized for healthcare professionals directly involved in the care of patients.

Please note, standby registration DOES NOT GUARANTEE participation in the session or meal service. If you have any questions, please feel free to contact us via email at Meetings@ResearchToPractice.com or call (800) 233-6153.