DR BROWN: Lenalidomide is not as well tolerated by CLL patients as it is by other lymphoma patients. And I think that makes it hard to give when you compare it to a BCR pathway inhibitor, which is usually better tolerated. My impression is that less heavily pretreated patients with lesser disease burdens do better with lenalidomide than patients who are heavily pretreated or get more cytopenic.

The other issue is you have to be able to deliver the drug for an extended period to get the very high-quality remissions. And sometimes patients just don’t tolerate it that long. It may be the case that elderly patients is a place that one can look, but there are obviously concerns about reduced renal function and the tumor lysis that has been seen in the early studies with lenalidomide in CLL as well as in the lenalidomide versus chlorambucil potential registration trial.

DR KANTARJIAN: So we have those discussions in the leukemia meeting, because we are trying to design our front-line and salvage therapies. And one of the interesting idea is the combination of lenalidomide with the checkpoint inhibitors. And this is where we can potentially go in terms of inducing a solid remission, and then patients who have minimal residual disease positivity could be treated on either pilots or in randomized fashions to lenalidomide maintenance with or without the monoclonal or with or without the checkpoint inhibitor. So we’re starting a pilot study along this line, and we’ll see. But there are so many good things happening in CLL. Again, like ALL, it appears to be a revolutionary period in the management. And we have so many options that we struggle with what would be the next best thing in terms of investigational therapies to offer to our patients.

Chronic Lymphocytic Leukemia (CLL)

Chronic Myeloid Leukemia (CML)

Acute Myeloid Leukemia (AML) and Acute Promyelocytic Leukemia (APL)

Myelodysplastic Syndromes (MDS)

Acute Lymphocytic Leukemia (ALL)