The ONS Podcast

"It's a chronic disease. It never goes away for some people, and so therefore it has these periods of remission where it's really quiet and well controlled. Then there can be periods of flares where you're actively engaged in treatment or it's impacting other pieces. There's this feeling patients have of, 'When am I going to have that flare?' You know, this anticipatory anxiety of, 'When are things going to be done differently?' or 'When do I need to change?'" ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about long-term chronic lymphocytic leukemia (CLL) considerations for oncology nurses.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.5 contact hours of nursing continuing professional development (NCPD), including 15 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by September 11, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to the nursing considerations of caring for people with long-term CLL.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses
Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses
Episode 256: Cancer Symptom Management Basics: Hematologic Complications
Episode 201: Which Survivorship Care Model Is Right for Your Patient?

ONS Voice articles: Cardio-Oncology Program Monitors Heart Toxicities Throughout Survivorship
Fixed-Duration Therapy for CLL May Lower Cardiovascular Risks and Costs Less Than Continuous Treatment
Individuals With CLL Face Increased Risk for Skin Cancer
Patients With CLL Report Worse QoL and Other Factors

Clinical Journal of Oncology Nursing articles:  In Remission: A Patient's Experience of Continued Care After Chronic Lymphocytic Leukemia
Venetoclax: Management and Care for Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia

ONS book: Site-Specific Cancer Series: Leukemia (first edition)
ONS Learning Libraries: Hematology, Cellular Therapy, and Stem Cell Transplantation Learning Library
Survivorship Learning Library

ONS Symptom Management Resources:  Prevention of Bleeding
Prevention of Infection: General

CLL Society: Living With CLL
Lymphoma Research Foundation: Remission and Long-Term Survivorship
National Comprehensive Cancer Network
To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"I think about the immunocompromised state that often comes from the CD20 monoclonal antibodies such as obinutuzumab, rituximab, and ofatumumab. All of those are agents that have been used in CLL, and they can lead to hypogammaglobulinemia. That is something that can be short-lived right after therapy, but can be prolonged or even a lifelong status after receiving these types of therapies. And then some of the other pieces that we think about are increased risk of basal cell carcinoma, routine skin exams, and maintaining some of those components of evaluation, monitoring, and preventative types of health care." TS 1:57
"We think about how we comanage some of these comorbidities, especially cardiovascular. … The evolution of cardio-oncology programs has been incredibly valuable, specifically for a lot of agents that have such a significant impact on the risk of developing hypertension but also on the potential for atrial fibrillation. When we think about our aging population and common cardiovascular risks, cardio-oncology has been an incredible partner to be able to collaborate and effectively manage their cardiovascular health in a way that keeps that risk reduction strategy in place, but also allows us to maintain these really effective oncologic agents." TS 4:50
"When we think about indefinite therapy, the consideration is that patients are on a therapeutic agent for as long as that agent is working, so there's no set time that is indicated. We oftentimes talk about cycle length or a year of therapy or things like that. But when we think about indefinite treatment, it's really a shift in the perspective of looking at CLL like a chronic disease that is continually being managed. I think this is when we partner and think about other comorbidities that we manage, such as hypertension. You have to take something every day to effectively manage this disease. And so this is what we think about with indefinite treatment—that the patient is going to be receiving treatment or engaged in taking these agents for as long as they're working and it's giving the patient the intended benefit." TS 12:30
"CLL might not be something that requires an action plan. There's a lot of active surveillance and routine monitoring, and there's not really something the patient can do to say, 'I'm kind of in the driver's seat.' I think this is one of those components that really ties together what we can advocate for our patients to be doing to reduce the risk of complications. I often talk about immunizations and vaccines and really staying up to date because that's going to be the most effective way for them to reduce the risk of infections." TS 15:01
"Everyone's going to need different support, but there's so much opportunity to really provide a meaningful quality of life. Whether patients are on active surveillance or have never needed therapy, if they need periods of treatment or are off therapy, or if they're continuously on therapy, I think that there are a lot of things that we can do to advocate for them to have a really good quality of life and be able to live fully with this diagnosis." TS 27:44

"Think about all the important things our kidneys do for the body. Those things are compromised. If we have excess buildup of toxins and waste in the body, you're having problems with fluid reabsorption. Then you have also problems with electrolytes not being balanced. Then in turn, you have ongoing shutdown of systems. So the cardiopulmonary system gets compromise. Your circulatory system then gets compromised. And then all the things in the body that depend upon ongoing circulatory flow are then causing major resets in the system that need to be addressed," ONS member Brenda S. Nettles, DNP, MS, ACNP-BC, AOCNP, CNE, assistant professor at the Johns Hopkins School of Nursing and nurse practitioner at Johns Hopkins Hospital in Baltimore, MD, told Madeline Johnston, MSN, RN, OCN®, oncology clinical specialist at ONS, during a conversation about urinary obstructions.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.25 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by September 4, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge relating to urinary obstruction as an oncologic emergency.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes:
Oncologic Emergencies 101 series
Episode 424: Radiation Site-Specific Side Effects: Cancers of the Pelvis
Episode 394: Prostate Cancer Survivorship Considerations for Nurses
Episode 390: Prostate Cancer Treatment Considerations for Nurses
Episode 387: Prostate Cancer Screening, Early Detection, and Disparities
ONS Voice articles:
A Primer on Urothelial Cancer
Oncology Urgent Care Provides the Right Place, Right Time, and Right Treatment for Patients Experiencing Cancer-Related Emergencies
In the Event of an Oncologic Emergency, Make Sure You're Prepared to Deliver Compassionate, Life-Saving Care
ONS book: Understanding and Managing Oncologic Emergencies: Traditional and Emerging
ONS course: ONS Oncologic Emergencies™
ONS Oncologic Emergencies Learning Library
American Cancer Society anatomy galleries:
Female Genitourinary System
Male Genitourinary System
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"As far as diagnoses go, I think that the ones that we see most common are impacted by the actual genitourinary system itself being impacted, so your patients with prostate cancer and patients with bladder cancer are definitely the ones that we see most often. But you'll see that it's also in individuals that have a diagnosis of either mucinous neoplasms or invasive peritoneal disease that invades all the cavities of the body—and also your sarcomas, because they also will actually the involve different parts of the renal system as part of their spread pattern." TS 3:55
"The first thing you want to do is try to eliminate the causative factor. So what's causing the obstruction? If there's something that's limiting flow because of the compression from the outside of the ureter or compressing around the kidney itself that they can't drain adequately, then you can look at ways to manage that by inserting a nephrostomy tube into the kidney. You can also put in ureteral stents to help alleviate the pressure from drainage from the kidney to the ureter and into the bladder." TS 7:20
"It's very common when people have a partial obstruction to have still some degree of urinary output. But the key thing is looking at, over time, how that may change. So if they do develop some progressive symptoms of the flank pain, and then also renal function begins to get a little bit lower and lower over time. Hematuria or signs of infection—those are again that next-level discussion that needs to be had about what gets evaluated next to confirm a possible obstruction." TS 10:00
"The biggest misconception, I believe, would be that you have time to figure it out. And the individual that already has immunocompromised states and also possible decline in baseline renal function have very low thresholds for us to really wait on these things too long. It's always better to err on the side of caution and do at least the due diligence of minimal evaluation by looking at the individual's vital signs and looking at their ability to still have urine output. Then if that's now compromised, work further into the process in a more timely manner." TS 13:47
"It's always good to have a refresher about how to manage different types of urinary diversion systems, so check with your facility in regards to what they carry for nephrostomy tube devices and the maintenance plans they have for those as far as frequency of flushing. So you can be a problem solver for your individual that has these diversion devices place for urinary obstructions." TS 16:19

"If you are considering board service, I would say take the leap. Start with your local chapter. It will give you some valuable skills that will help prepare you when you are applying for your national level. And I always say, if you want to do it, just do it because what's the worst that can happen? They can say no, but that doesn't mean that you will never serve on a board. I always tell people delayed is not denied," Cassandra Green, DNP, RN, OCN®, ONS member and past president of the Oncology Nursing Certification Corporation (ONCC) Board of Directors, told Evelyn Wempe, DNP, MBA, APRN, ACNP-BC, AOCNP®, CRN, NEA-BC, chair of the ONS Leadership Succession Committee (formerly known as the Leadership Development Committee), during a conversation about service on a board of directors. Wempe spoke with Green and ONS members Kristin Ferguson, DNP, MBA, RN, OCN®, CGNC, former treasurer and director-at-large on the ONS Board of Directors, and Yanka Campbell, DNP, RN, CPHQ, AGPCNP-BC, CNE, member of the Oncology Nursing Foundation (ONF) Board of Directors, about their experiences with board service.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by August 28, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to serving on a board of directors for a professional organization.
Episode Notes
Complete this evaluation for free NCPD.
ONS Podcast™ episodes:
Meet the ONS Board of Directors series
Episode 342: What It's Like to Serve on the Leadership Development Committee
ONS Voice articles:
Could Today Be the Start of Your ONS Leadership Journey?
Nursing Leadership Unlocked
Leading With Purpose Creates a Vision for the Future of Oncology Nursing
ONS courses:
A Guide to Chapter Leadership: Chapter President Training
Board Leadership: Nurses in Governance
Clinical Journal of Oncology Nursing article: Rearview Mirror Leadership: Looking Backward to Move Forward
ONS Board Self-Assessment
ONS Leadership
ONCC Board of Directors
ONF Leadership
Your Roadmap to Future Service on the ONS Board of Directors
ONS Leadership Learning Library
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
Campbell: "Joining a board was a natural next step for me to maintain my connection to bedside nursing that I've loved for so many years, and to find a way to give back to advanced practice nurses as well in this role. The Oncology Nursing Society and Foundation were especially meaningful for me because I knew firsthand the importance of having scholarship, research, funding, and leadership development programs that can really change the trajectory of a nurse's career. I realized I wanted to help shape the opportunities that were available to me for future nurses, and I just did not want to continue to do that through one-on-one mentorships, which I have done extensively throughout my career, but find a way to help more broadly toward guiding organizational mission and strategic objectives." TS 7:20
Green: "Everyone was so welcoming on the board. Everyone was so friendly. One of the first things I remember our executive director Tony Ellis telling me is, 'Most of our new board members are really quiet and reserved at our first meeting. They just kind of keep things to themselves. They don't ask a lot of questions.' I don't know if they were prepared for me because I came in with guns a-blazing, and I had lots of questions. I was not quiet. I was very involved and very vocal. I still am, but that was one of the best experiences ever. Before that, I had never really been in a board setting other than my local chapter, and even then, I was just starting to be in that setting because I was the president of my local chapter and on the [ONCC] Board of Directors at the same time." TS 10:29
Ferguson: "A nonclinical mentor I would absolutely identify would be Alec Stone, who used to be the ONS director of public affairs. … He helped me to learn a lot about health policy and advocacy and the impact a nurse's voice can have. Learning how to speak about my experiences in health care in public by doing programs like the Nurses in Washington Internship … or ONS's Capitol Hill Days ended up giving me a lot more confidence that I didn't know I would have in expressing my point of view and being very open and collegial and expressing my opinions. … This really lent itself well to my future board experience because, as Cassandra mentioned, board members have to speak their mind and speak up at the meetings." TS 12:11
Campbell: "One of the most unexpected benefits was when I reached out to my executive leadership team at the Kimmel Cancer Center at Johns Hopkins and said, 'I'm being considered to serve on the ONF Board. This is going to require me taking time away from work to attend meetings, to attend some in-person meetings. And then it would be really wonderful at the institution if I'm able to also financially impact the nurses who need to benefit from what I've benefited from in my career.' Usually when you have those conversations, you are expecting to present a deck of PowerPoint slides to make your case, but the answer from my leadership team in participating in ONF and supporting the Board was an immediate yes. It was 'Yes, when can you start? Yes, what can we do to support you?' And really making sure that I had dedicated time to be fully present." TS 14:15
Ferguson: "There are many skills and experiences that can lend themselves to being a strong board member. … The ability to speak your mind clearly and express your thoughts, which really boils down to strong communication skills. We are lucky in our careers. We all have worked as nurses in different settings and health care, and nurses are naturally skilled and good at communication. We learn strategies like SBAR—situation, background assessment, recommendation. Nurses every day are communicating in their places of work, oftentimes with patients who are sick and need education, or perhaps with new nurses they're teaching or mentoring. And they are communicating with non-nurses, as well, and nonpatients, so clinical roles and nonclinical roles. So nurses already have a good understanding of best practices when it comes to communication, and this can lend itself well to any board position." TS 21:04
Green: "When you [come into a] leadership role, I think that's when we learn most about ourselves and what we expect. And be the leader type of leader that you want to be and the type of leader that you would like to work with so that you can make your experience valuable and pleasurable." TS 28:57

"They're really worried that radiation is going to be painful. So they come in for that first day of treatment very anxious. With our patients with brain cancer, we're using the masks on the table, and those masks are very tight and hold their heads very, very still. So they'll be very worried about being claustrophobic. We may start out the first day or two with a little bit of [lorazepam]. And they'll come to me and they'll say, 'This really hasn't been as bad as I thought it was going to be,'" ONS member Catherine McCluskey, BSN, RN, OCN®, ROCN™, radiation oncology staff nurse at Atrium Health Wake Forest Baptist in Winston-Salem, NC, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, who was the manager of oncology nursing practice at ONS at the time of the recording, during a conversation about radiation side effects in central nervous system (CNS) cancers.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by August 21, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to the side effects of radiation to treat CNS cancer.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes:
Radiation Site-Specific Side Effects series
Episode 306: Cancer Symptom Management Basics: CNS Toxicities
ONS Voice articles:
Augmented Reality Simulations Reduce Patient Anxiety by Teaching Them About Radiation Therapy
CNS Survivorship Needs More Research, Funding, and Training, Expert Panel Says
Here's What the Updated CTCAE Version 6.0 Means for Oncology Nurses
Highly Localized, Precision Radiation Therapies Require Nurses to Drive Care Coordination, Patient Education
Hyperbaric Oxygen Therapy Shows Promise for Certain Radiation Side Effects
ONS book: Manual for Radiation Oncology Nursing Practice and Education (fifth edition)
ONS courses:
Indications of Targeted Radiotherapy to the Brain and Spine: 2025 ONS Congress® Session
ONS ROCN™ Certification Review™
ONS/ONCC® Radiation Therapy Certificate™
Supporting Radiation Side Effect Management Through ONS Evidence-Based Resources: 2025 ONS Congress® Session
Clinical Journal of Oncology Nursing articles:
Implementing a Standardized Educational Tool for Patients With Brain Tumors Undergoing Concurrent Temozolomide and Radiation Therapy
Radiation Necrosis: A Differential Diagnosis Dilemma
The Neurocognitive Late Effects of Cranial Radiation Therapy: The Often-Unrecognized Outcomes
Oncology Nursing Forum article: Symptom Clusters in Patients With Brain Tumors Undergoing Proton Beam Therapy
ONS Huddle Cards:
External Beam Radiation
Proton Therapy Proton Therapy
Radiation
ONS Guidelines™ and Symptom Management Resources
Cognitive impairment
Fatigue
Mucositis
Radiodermatitis
ONCC resources:
Big List of CE
Radiation Oncology Certified Nurse (ROCN™)
Common Terminology Criteria for Adverse Events (CTCAE v6.0)
Patient Health Questionnaire (PHQ-9 and PHQ-2)
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"With primary tumors—glioblastomas, astrocytoma, all of those types of cancerous primary CNS tumors, the tumors are not very well-defined. They have little tentacles that kind of go out, so doing something like Gamma Knife, which is very precise, is not as effective as an external beam because the external beam will deliver radiation to all those little tentacles that are out there in the brain. And with Gamma Knife, you really can't effectively do that." TS 2:34
"When we're doing radiation to the brain, fortunately there aren't that many acute toxicities involved. Sometimes they'll have some mild dermatitis. Usually, it's not very significant. They, like everyone else who gets radiation, will have fatigue. Usually once we get to the end of the second week of radiation, into the third week for our patients with primary CNS tumors—the hair loss—they'll start to notice hair loss just in the treatment area. But those are typical, the things that we've seen most. Sometimes we'll have patients who will experience some nausea, maybe a few headaches, but really the acute toxicities are not severe typically with our patients with brain tumors." TS 8:30
"[For] the fatigue, I tell patients to just listen to their bodies. We don't want them to be sedentary, and we want them to go out and continue living their lives. But I do warn them that the fatigue is pretty much common to all patients receiving radiation at various degrees, depending on the patient. I just tell them to do what they feel like doing, and then when they're tired to rest, and if they find themselves having a nap in the afternoon, that's okay." TS 13:51
"What I find with these patients in particular is that a lot of times, their first symptoms related to any type of cancer are CNS symptoms from brain metastasis. Our patients with lung cancer or melanoma—they come in through the emergency room for altered mental status or seizures or something like that. They find a mass in their brain, and then they find a mass on their lung, or they find masses everywhere. Typically, they want to treat the brain masses first before they start them on any kind of systemic treatment. And so, they'll come to us, and they're in shock. Everything's happened very quickly. They haven't had a chance to really catch their breath. They're overwhelmed. And so I try to make sure they understand that everyone that they see here is part of their team and is with them through this journey and they're not alone." TS 25:36
"A couple of years ago, ONS put out an email asking for people to volunteer to do a delineation study about the feasibility of doing a radiation oncology certified nursing exam. And I, just on a whim, responded to that email. It's not something I've ever done before, and thinking that I would not be put on the team. … And I thought, 'I don't have enough experience, I don't know what I'm doing, and they won't choose me.' And lo and behold, they put me on this role delineation study. … I have met so many incredible nurses with all kinds of experience. I've learned so much. It has opened up a lot of things for me and it's been really exciting, so all I can do is say take advantage of those opportunities when they come. Don't think that you don't know enough, because you know more than you think you do." TS 32:38

"Measurable residual disease is where I think the terminology fits best in that, it is intended to measure the amount of cancer cells that are present in the blood or bone marrow at the time the sample was collected. We can identify one cancer cell in a million. Where that can be really valuable is when we start to think about the duration of treatments and the response to some of our treatments," ONS member Caitlin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist at ONS, during a conversation about chronic lymphocytic leukemia (CLL) treatment considerations for oncology nurses.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0 
Earn 0.75 contact hours of nursing continuing professional development (NCPD), including 45 minutes of pharmacotherapeutic content, by listening to the full recording and completing an evaluation at courses.ons.org by August 14, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Learners will report an increase in knowledge related to treatment of chronic lymphocytic leukemia.
Episode Notes 
Complete this evaluation for free NCPD. 
ONS Podcast™ episodes: Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses
Episode 256: Cancer Symptom Management Basics: Hematologic Complications
Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis
Episode 184: Oncologic Emergencies 101: Tumor Lysis Syndrome

ONS Voice articles: Fixed-Duration Therapy for CLL May Lower Cardiovascular Risks and Costs Less Than Continuous Treatment
Individuals With CLL Face Increased Risk for Skin Cancer
Master Hypersensitivity Reactions With These Strategies for Prevention and Management
Patients With CLL Report Worse QoL and Other Factors

Clinical Journal of Oncology Nursing articles:  Acalabrutinib: Nursing Considerations for Use in Patients With Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma
Pseudohyperkalemia in Chronic Lymphocytic Leukemia: An Often Overlooked Clinical Entity
Richter Transformation Arising From Chronic Lymphocytic Leukemia
Venetoclax: Management and Care for Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia

ONS book: Site-Specific Cancer Series: Leukemia (first edition)
ONS symptom management resources:  Fatigue
Prevention of Bleeding
Prevention of Infection: General

Blood Cancer United: Chronic Lymphocytic Leukemia Treatment
CLL Society: Patient Education Toolkit
Lymphoma Research Foundation: Lymphoma Treatments
Patient education sheets Acalabrutinib
Ibrutinib
Pirtobrutinib

To discuss the information in this episode with other oncology nurses, visit the ONS Communities. 
To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From This Episode
"Blood work is a really nice way to evaluate if there is progression of the disease. And we evaluate their blood counts, specifically that complete blood count with a differential. We anticipate an elevated white count, and we anticipate that the absolute lymphocyte count is going to be elevated. That's characteristic of the disease. But what evolves and happens is that those numbers can rapidly change and what we get concerned about is if that white count—and the percentage of the absolute lymphocyte count specifically—starts to increase and double quickly." TS 5:52
"There are some components that help clinicians decide if we expect these things, this cadence of change to happen more readily, or if we feel really comfortable that the biology of the variants contributing to the type of CLL that each patient may have, they may not have that progression as quickly or at all. And so that kind of helps us in that follow-up and cadence. Oftentimes, we're checking blood work every three or six months. Some patients are on an annual interval of visits depending on that active surveillance. I think the other piece is that we have a relatively low threshold when there is a change in symptoms to just recheck those blood tests. It's nice that we can have a pretty readily available blood test to be able to give us a lot of information for these patients." TS 9:45
"When we think about CLL therapy, the old tried and true [treatments] still work: so, rituximab and obinutuzumab. And then we kind of start to think about pathways and the way, the mechanisms of which these treatments are integrated. We think about different pathways of how we can induce cell death, but also what are the potential side effects? What are the potential interactions?" TS 19:35
"I think a lot of this is about really having a clear understanding of the patient's goals and really being able to understand and align. I think we have a lot more data to provide guidance for those patients that really are wanting to know: What is my chance of overall survival? If I do this, does this mean that I don't need to ever be on treatment again? If I do it this way, does it mean that I have to come into clinic every week, or does it mean that I have to come in every week but I'm done? I do one year of treatment, and I don't have to think about treatment for a really long time based on some of these components that we can take into consideration." TS 24:36
"When we think about the B-cell lymphoma 2 (BCL-2) inhibitors, with venetoclax, I think the biggest component we think about is tumor lysis syndrome. It's so effective that these cancer cells release all of those electrolytes, potassium, phosphorus; you can see a rise in the lactate dehydrogenase and uric acid because those cells are breaking down. And so subsequently, that leads us to the consideration of, is the patient's kidney function able to clear it? And so a lot of frequent lab monitoring, a lot of hydration, supportive care with medications like ursodiol or allopurinol to really improve the ability to clear that cellular waste product so that it doesn't cause an oncologic emergency." TS 34:11