Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses
Release Date: 08/14/2026
Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses
The ONS Podcast
“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 Caitilin 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...
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Episode 427: Pharmacology 101: Resistance Pathways
The ONS Podcast
“A good way of thinking about this is this is the survival of the fittest clone. There could be a portion of a cancer that naturally has some resistance or ability to survive a particular drug. And over time, as the other cells around it are dying off, that particular clone is able to replicate and continue to survive in the face of that drug therapy and eventually take over as being the fittest clone. At that point, we’re often seeing disease progression,” Danielle Roman, PharmD, BCOP, manager of clinical pharmacy services at the Allegheny Health Network Cancer Institute in Pittsburgh,...
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Episode 426: Tools to Support Patients and Nurses Through Medical Trauma in Oncology
The ONS Podcast
“When people with PTSD [post-traumatic stress disorder] get quite avoidant—and that can be expressed in so many different ways—the implications can be really profound. I think an important invitation to oncologists and oncology nurses and primary care providers who care for people battling cancer is let’s explore what's underneath these avoidant behaviors. Is it a very practical thing? Or is it that underneath this avoidant behavior is really profound fear?” James C. Jackson, PsyD, research professor at Vanderbilt University Medical Center in Nashville, TN, told Lenise Taylor, MN,...
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Episode 425: How AI Can Help Healthcare Organizations Improve the Cancer Experience
The ONS Podcast
“In oncology specifically, where care is complex, artificial intelligence (AI) can really synthesize large volumes of clinical information, flag risks such as treatment complications, and support adherence to evidence-based pathways. For nurses specifically, this enables them more time for direct patient care, clinical judgment, and care coordination, and really practice to the top of their license while reducing repetitive time and administrative tasks,” Jenn Frith, DNP, RN, OCN®, NE-BC, associate vice president of clinical operations at Duke Cancer Institute in Durham, NC, told Jaime...
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Episode 424: Radiation Site-Specific Side Effects: Cancers of the Pelvis
The ONS Podcast
“Think about what organs lie in the radiation field, and anything that lies in that radiation field is likely going to have some potential temporary—hopefully temporary—side effects. If you think about the pelvis, the things that live in there are the bladder, urethra, some bowel, rectum, reproductive organs, skin, some lymph nodes. And so, all of those things could potentially have associated side effects,” ONS member Kayla Kafka-Peterson, BSN, RN, ROCN™, nurse navigator and leader in the brachytherapy and peri-anesthesia programs at UCLA Health, in Los Angeles, CA, told Lenise...
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Episode 423: Pharmacology 101: Interaction Pathways
The ONS Podcast
“When we think of drug interactions, specifically, the National Cancer Institute actually defines this as a change in the way a drug acts in the body when taken with certain other drugs, herbals, or foods or when taken with certain medical conditions. Drug interactions may cause the drug to either be more or less effective or cause effects on the body that are not expected,” Carissa Ganihong, PharmD, BCOP, oncology and bone marrow transplantation clinical pharmacist at Hackensack University Medical Center in New Jersey, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology...
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Episode 422: An Overview of Chronic Lymphocytic Leukemia for Oncology Nurses
The ONS Podcast
“What I appreciate about our patients with chronic lymphocytic leukemia (CLL) or small lymphocytic leukemia is the consideration that they receive a cancer diagnosis, and the best thing for them to do is actually nothing. There is a large population of patients that we don’t recommend any type of treatment. We recommend that they establish care with an oncologist and that they have a relationship with those care teams,” ONS member Caitilin Murphy, DNP, APRN, FNP-BC, AOCNP®, chief nurse practitioner at Dana-Farber Cancer Institute in Boston, MA, told Lenise Taylor, MN, RN, AOCNS®,...
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Episode 421: Medical Trauma in Oncology
The ONS Podcast
“There are a huge array of medical dynamics that people endure, and when they leave a lasting impact, a word that we don’t use widely enough is the word ‘trauma.’ There’s an entire category of phenomena in the medical arena that are, in fact, traumatic. One way we know that these experiences are traumatic is that we know that huge portions of people who experience things like cancer do indeed develop problems like [post-traumatic stress disorder],” James C. Jackson, PsyD, research professor at Vanderbilt University Medical Center in Nashville, TN, told Jaime Weimer, MSN, RN,...
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Episode 420: Long-Term Myelodysplastic Syndrome Considerations for Oncology Nurses
The ONS Podcast
“We typically think of the disease progressing for our higher-risk patients because many of them already start with increased blasts or a lot of dysplasia. And they have these chromosomal variants that make them prone to evolving into acute myeloid leukemia (AML). With them, we can anticipate that they are going to progress to AML. And that’s what we’re trying to prevent. It’s kind of like a biologic evolution and not a switch,” ONS member Sara Tinsley-Vance, PhD, APRN, AOCN®, nurse practitioner and quality-of-life researcher at Moffitt Cancer Center in Tampa, FL, told Lenise...
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Episode 419: Pharmacology 101: Immunomodulators
The ONS Podcast
“Until immunomodulators, patients [with myeloma] did not have a great overall survival rate. But when we introduced lenalidomide, we started seeing our patients have life expectancies between five and seven years—which was unheard of prior to these immunomodulators going forward. I think it’s promising and allows patients to have quality of life versus therapy of life,” ONS member Daniel Verina, DNP, RN, ACNP-BC, nurse practitioner for the multiple myeloma program at Mount Sinai Medical Center in New York, NY, told Lenise Taylor, MN, RN, AOCNS®, TCTCN™, oncology clinical specialist...
info_outline“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 Caitilin 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:
- ONS Voice articles:
- 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:
- Blood Cancer United: Chronic Lymphocytic Leukemia Treatment
- CLL Society: Patient Education Toolkit
- Lymphoma Research Foundation: Lymphoma Treatments
- Patient education sheets
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