References

Awan FT, Schuh A, Brown JR Acalabrutinib monotherapy in patients with chronic lymphocytic leukemia who are intolerant to ibrutinib. Blood Adv. 2019; 3:(9)1553-1562 https://doi.org/10.1182/bloodadvances.2018030007

Badillo M, Nava D, Rosa M, Chen W, Guerrero M, Wang M. Acalabrutinib: Managing Adverse Events and Improving Adherence in Patients With Mantle Cell Lymphoma. Clin J Oncol Nurs. 2020; 24:(4)392-398 https://doi.org/10.1188/20.CJON.392-398

Bassan F, Peter F, Houbre B Adherence to oral antineoplastic agents by cancer patients: definition and literature review. Eur J Cancer Care (Engl). 2014; 23:(1)22-35 https://doi.org/10.1111/ecc.12124

Bosch F, Hallek M. Venetoclax after idelalisib: relevant progress for CLL. Blood. 2018; 131:(15)1632-1633 https://doi.org/10.1182/blood-2018-02-826396

Brown JR, Hillmen P, O'Brien S Extended follow-up and impact of high-risk prognostic factors from the phase 3 RESONATE study in patients with previously treated CLL/SLL. Leukemia. 2018; 32:(1)83-91 https://doi.org/10.1038/leu.2017.175

JNCCN Spotlights Acalabrutinib. 2020. https://inccn360.orq/cII/inccn-spotliqhts/acalabrutinib/ (accessed 23 August 2021)

Byrd JC, Harrington B, O'Brien S Acalabrutinib (ACP-196) in Relapsed Chronic Lymphocytic Leukemia. N Engl J Med. 2016; 374:(4)323-332 https://doi.org/10.1056/NEJMoa1509981

Byrd JC, Wierda WG, Schuh A Acalabrutinib monotherapy in patients with relapsed/refractory chronic lymphocytic leukemia: updated phase 2 results. Blood. 2020; 135:(15)1204-1213 https://doi.org/10.1182/blood.2018884940

Byrd JC, Woyach JA, Furman RR Acalabrutinib in treatment-naive chronic lymphocytic leukemia. Blood. 2021; 137:(24)3327-3338 https://doi.org/10.1182/blood.2020009617

Burger JA. Treatment of Chronic Lymphocytic Leukemia. N Engl J Med. 2020; 383:(5)460-473 https://doi.org/10.1056/NEJMra1908213

Call TG, Norman AD, Hanson CA Incidence of chronic lymphocytic leukemia and high-count monoclonal B-cell lymphocytosis using the 2008 guidelines. Cancer. 2014; 120:(13)2000-2005 https://doi.org/10.1002/cncr.28690

Condoluci A, Terzi di Bergamo L, Langerbeins P International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia. Blood. 2020; 135:(21)1859-1869 https://doi.org/10.1182/blood.2019003453

ClinicaltriaIs.gov. Study of Acalabrutinib (ACP-196) Versus Ibrutinib in Previously Treated Subjects With High Risk CLL. 2015. https://www.cIinicaItriaIs.qov/ct2/show/NCT02477696 (accessed 18 August 2021)

Delgado J, Nadeu F, Colomer D, Campo E. Chronic lymphocytic leukemia: from molecular pathogenesis to novel therapeutic strategies. Haematologica. 2020; 105:(9)2205-2217 https://doi.org/10.3324/haematol.2019.236000

Dowling M, Hunter A, Biesty L Driving and Disabling Factors of Noncurative Oral Chemotherapy Adherence: A Qualitative Evidence Synthesis. Oncol Nurs Forum. 2019; 46:(1)16-28 https://doi.org/10.1188/19.ONF.16-28

Furman RR, Sharman JP, Coutre SE Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med. 2014; 370:(11)997-1007 https://doi.org/10.1056/NEJMoa1315226

Ghia P, Pluta A, Wach M ASCEND: Phase III, Randomized Trial of Acalabrutinib Versus Idelalisib Plus Rituximab or Bendamustine Plus Rituximab in Relapsed or Refractory Chronic Lymphocytic Leukemia. J Clin Oncol. 2020; 38:(25)2849-2861 https://doi.org/10.1200/JCO.19.03355

An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data. Lancet Oncol. 2016; 17:(6)779-790 https://doi.org/10.1016/S1470-2045(16)30029-8

Kaptein AA, Schoones JW, van der Meer PB Psychosocial determinants of adherence with oral anticancer treatment: ‘we don't need no education’. Acta Oncol. 2021; 60:(1)87-95 https://doi.org/10.1080/0284186X.2020.1843190

Kav S, Schulmeister L, Nirenberg A, Barber L, Johnson J, Rittenberg C. Development of the MASCC Teaching Tool for Patients Receiving Oral Agents for Cancer. Support Care Cancer. 2010; 18:(5)583-590 https://doi.org/10.1007/s00520-009-0692-5

Kongshaug N, Skolbekken JA, Faxvaag A, Hofsli E. Cancer Patients' Perceived Value of a Smartphone App to Enhance the Safety of Home-Based Chemotherapy: Feasibility Study. JMIR Form Res. 2021; 5:(1) https://doi.org/10.2196/20636

Lipsky A, Lamanna N. Managing toxicities of Bruton tyrosine kinase inhibitors. Hematology Am Soc Hematol Educ Program. 2020; 2020:(1)336-345 https://doi.org/10.1182/hematology.2020000118

Mawhinney MW, Warden J, Stoner N. The oral education clinic: A pharmacist-and nurse-led clinic to support patients starting oral systemic anti-cancer treatments. J Oncol Pharm Pract. 2019; 25:(2)449-453 https://doi.org/10.1177/1078155217727820

Milne K, Sturrock B, Chevassut T. Chronic Lymphocytic Leukaemia in 2020: the Future Has Arrived. Curr Oncol Rep. 2020; 22:(4) https://doi.org/10.1007/s11912-020-0893-0

Nam J. Acalabrutinib (Calquence). Oncology Nurse Advisor 8. 2017; 6:36-38

Neuss MN, Polovich M, McNiff K 2013 updated American Society of Clinical Oncology/Oncology Nursing Society chemotherapy administration safety standards including standards for the safe administration and management of oral chemotherapy. J Oncol Pract. 2013; 9:5s-13s https://doi.org/10.1200/JOP.2013.000874

National Comprehensive Cancer Network (NCCN). Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Version 4.2021-April 29, 2021. 2021. http://www.nccn.orq

NICE. Chemotherapy-free treatment options to be offered to patients with England's most common leukaemia. 2021. https://www.nice.orq.uk/news/article/acalabrutinib-for-treatinq-chronic-lvphocytic-leukaemia-ta689 (accessed 21 August 2021)

O'Brien SM, Brown JR, Byrd JC Monitoring and Managing BTK Inhibitor Treatment-Related Adverse Events in Clinical Practice. Front Oncol. 2021; 11 https://doi.org/10.3389/fonc.2021.720704

Pal Singh S, Dammeijer F, Hendriks RW. Role of Bruton's tyrosine kinase in B cells and malignancies. Molecular Cancer. 2018; 17:(1)

Rittenberg C N. Meeting educational needs and enhancing adherence of patients receiving oral cancer agents through use of the MASCC oral agent teaching tools. European Oncology and Haematology. 2012; 8:(2)97-100

Rowland SP, Fitzgerald JE, Holme T, Powell J, McGregor A. What is the clinical value of mHealth for patients?. NPJ Digit Med. 2020; 3 https://doi.org/10.1038/s41746-019-0206-x

Adherence to Long-term Therapies — Evidence for Action. Geneva, WHO. 2003;

Schuh AH, Parry-Jones N, Appleby N Guideline for the treatment of chronic lymphocytic leukaemia: A British Society for Haematology Guideline. Br J Haematol. 2018; 182:(3)344-359 https://doi.org/10.1111/bjh.15460

Sharman JP, Egyed M, Jurczak W Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial. Lancet. 2020; 395:(10232)1278-1291 https://doi.org/10.1016/S0140-6736(20)30262-2

Skibola CF, Slager SL, Berndt SI Medical History, Lifestyle, Family History, and Occupational Risk Factors for Adult Acute Lymphocytic Leukemia: The InterLymph Non-Hodgkin Lymphoma Subtypes Project. JNCI Monographs. 2014; 2014:(48)125-129 https://doi.org/10.1093/jncimonographs/lgu009SPC.2021

European Medicines Agency. Calquence. 2020. https://www.ema.europa.eu/en/documents/product-information/calquence-epar-product-informationen.pdf (accessed 28 July 2021)

Thurmes P, Call T, Slager S Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia. Leukemia & Lymphoma. 2008; 49:(1)49-56 https://doi.org/10.1080/10428190701724785

Tolotti A, Pedrazzani C, Bonetti L, Bianchi M, Valcarenghi D. Patients' and Nurses' Perceptions of the Effectiveness of an Oral Cancer Agent Education Process: A Mixed-Methods Study. Cancer Nurs. 2021; 44:(3)E151-E162 https://doi.org/10.1097/NCC.0000000000000790

Wu J, Zhang M, Liu D. Acalabrutinib (ACP-196): a selective second-generation BTK inhibitor. J Hematol Oncol. 2016; 9 https://doi.org/10.1186/s13045–016–0250-9

Acalabrutinib in the management of chronic lymphocytic leukaemia

02 February 2022
Volume 4 · Issue 2

Abstract

Chronic lymphocytic leukaemia (CLL) is the most common leukaemia worldwide. This article explores the management of CLL with a particular focus on the role of acalabrutinib in managing patients with CLL under NICE guidelines. Acalabrutinib is a potent bruton tyrosine kinase (BTK) inhibitor. Its use requires careful assessment, monitoring and early intervention to minimise side effects and maintain patients on treatment. Continuity of patient care and promotion of adherence and compliance is essential, particularly in light of the indefinite treatment duration. Patient education is central to therapeutic adherence of oral anti-cancer drugs, and nurses are ideally positioned to educate and support patients with CLL in collaboration with pharmacy colleagues. The benefits of nurse/pharmacy-led oral therapy clinics include continuity of care, consistency in information provision, efficient use of time with patients and carers, improved therapeutic relationships and an enhanced patient experience.

Chronic lymphocytic leukaemia (CLL) is the most common leukaemia worldwide, with 4.9 new cases per 100 000 per year in the UK (Milne et al, 2020). CLL is a lymphoproliferative disorder characterised by clonal proliferation and progressive accumulation of morphologically mature, monomorphic B lymphocytes in blood, bone marrow and lymphatic tissues (Burger 2020). In CLL, CD5+ B cells undergo malignant transformation and become continuously activated by the acquisition of mutations that lead to monoclonal B-cell lymphocytosis (MBL). Further accumulation of genetic abnormalities and subsequent oncogenic transformation of monoclonal B cells leads to CLL (Burger, 2020). CLL is considered identical to the indolent non-Hodgins lymphoma, small lymphocytic lymphoma (SLL). They both involve lymphocytes and are managed similarly. However, in CLL the disease is primarily found in blood and with SLL, it is primarily found in lymph nodes.

Register now to continue reading

Thank you for visiting Journal of Prescribing Practice and reading some of our peer-reviewed resources for prescribing professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month