Episode 428: Chronic Lymphocytic Leukemia Treatment Considerations for Oncology Nurses
Release Date: 08/14/2026
Episode 432: Long-Term Chronic Lymphocytic Leukemia Considerations for Oncology Nurses
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...
info_outline
Episode 431: Oncologic Emergencies 101: Urinary Obstruction
The ONS Podcast
“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....
info_outline
Episode 430: Leadership Unlocked: Is It Your Time to Serve?
The ONS Podcast
“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,...
info_outline
Episode 429: Radiation Site-Specific Side Effects: CNS Cancers
The ONS Podcast
“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...
info_outline
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 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...
info_outline
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,...
info_outline
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,...
info_outline
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...
info_outline
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...
info_outline
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...
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 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:
- 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