d:["$","html",null,{"style":{"fontFamily":"'__Barlow_c9fff9', '__Barlow_Fallback_c9fff9'","fontStyle":"normal"},"lang":{"global":{"site":"This site is intended for Canadian Healthcare Professionals.","submit":"Submit","back":"Back","savePage":"Save Page","logo1":"Communicate & Collaborate","logo2":"in Chronic Lymphocytic Leukemia","click":"Click to reveal","discussionPoint":"If you have any questions or would like to know more about anything you see here, please ask.","filteringNote1":"Note: the ± symbol means “with or without”","filteringNote2":"Note: the + symbol means “with”","treatments":{"acala":"Acalabrutinib","zanu":"Zanubrutinib","ibru":"Ibrutinib","venSolo":"Venetoclax","ven":"Venetoclax + Obinutuzumab","chemo":"Chemo-immunotherapy","acalabrutinib":"Acalabrutinib","zanubrutinib":"Zanubrutinib","ibrutinib":"Ibrutinib","venetoclax":"Venetoclax","venetoclaxIbrutinib":"Venetoclax + ibrutinib","obinutuzumab":"Obinutuzumab"}},"email":{"body":"Here are some of the items we discussed during your visit.","subject":"Resources on your CLL treatment"},"login":{"role":"Role:","physician":"Physician","nurse":"Nurse","pharmacist":"Pharmacist","province":"Province:","license":"License:","licensePlaceholder":"Please enter your medical license number","consent":"As a Canadian healthcare professional, by clicking REGISTER, I Consent to the collection, use and disclosure of my personal information for the purposes identified or described in the","privacyLink":"Privacy Policy","consentCont":", if applicable, or otherwise at the time of collection.","rememberMe":"Remember me","submit":"Sign In"},"index":{},"filtering":{"submit":"Submit","insurance":{"select":"Please select your insurance options"},"province":{"select":"Please select your Province/Territory"}},"nav":{"legal":"Legal Notice","privacy":"Privacy Policy","cookie":"Cookie Policy","report":"Report Adverse Event","contact":"Contact Us","support":"If you need support, please contact Kristin Serodio with Bridge Medical Communications via email","phoneAt":"or phone at","reset":"Reset Tool","cover":"Home","introduction":"Why You Are Here","discuss":"Getting Ready to Start Treatment","treatment-plan-based":"Your Health Factors","options":"Treatment Options","options-tabs":"Treatment Considerations","oss-tabs":"Treatment Outcomes","side-effects":"Side Effects","dosing":"Dosing","schedule":"Treatment Schedules","logistics":"Treatment Logistics","funding":"Funding","summary-questions":"Summary Questions","trial-summaries":"Clinical Trial Summaries","summary":"Patient Resources (Saved Pages)","references":"References","":"External Resources"},"cover":{"title":"Decision Aid","subtitle":"This decision aid was created to help people with CLL like you decide which treatment option suits you and your cancer.","intro":"In this Decision Aid, you will:","learn":"Learn about the benefits and risks of different treatment options","find":"Find out how to manage potential treatment side effects and get help if you need it","discuss":"Discuss and decide with your healthcare team, which treatment option is best for you","caregivers":"Your caregivers are also encouraged to participate in these discussions","start":"Let’s get started","committee":"Scientific Planning Committee","development":"Development of the C³ Decision Aid was directed by a Scientific Planning Committee of a Canadian multi-disciplinary team of healthcare providers, hematologists, a nurse, and pharmacists"},"getStarted":{"title":"What Will Your Treatment Journey Look Like?","subtitle":"We will discuss your treatment journey and considerations along the way","card1":{"title":"Your CLL Treatment Options","goals":"Goals of Initial Conversation","find":"Find out why you are here","discuss":"Discuss your treatment journey and get ready to start treatment","learn":"Learn about how your health factors may affect your treatment","learnMore":"Learn more about your treatment options"},"card2":{"title":"Choosing and Starting Your Treatment","goals":"Goals of Follow-up Conversation","review":"Review what you learned","learn":"Learn more about:","considerations":"Treatment considerations","outcomes":"Treatment outcomes","effects":"Side effects to look out for","dosing":"Dosing","receiving":"Receiving your treatment","discussing":"Discussing treatment coverage"},"card3":{"title":"Continuing Your Treatment","text":"Following your treatment plan gives you the best chance of optimizing your quality of life and keeping your CLL under control"}},"onboarding":{"welcome":"Welcome to the C³ Decision Aid.","intro":"If this is your first time going through this Decision Aid, please follow this quick onboarding tutorial to get to know the interface.","continue":"Continue to onboarding","usedBefore":"I’ve used this Decision Aid before.","start":"Skip onboarding","section1":{"first":{"title":"Progress bar","text":"Keep track of where you are in the Decision Aid. This can be clicked to go back to the Journey page."},"second":{"title":"C³ Logo","text":"Go back home by clicking the logo. This is available on every page."},"third":{"title":"Menu Section","text":"Here you have different toggles to view content depending on your insurance, province or language. You also have access to the menu to jump to various sections of the Decision Aid."}},"section2":{"first":{"title":"Back Button","text":"Click the back button to go to the previous section of the decision aid."},"second":{"title":"Save Page","text":"This button allows you to save this page on the Patient Resources page. Once the page is saved, you can view all of your saved pages at the very end and either print or email the information straight to the patient."},"third":{"title":"Questions Button","text":"Some pages will have this button as a reminder to ask your patient specific questions based on the content of the page. Click here to activate the popup."},"fourth":{"title":"Next Page","text":"Done reviewing this content? Hit next to continue through the decision aid."}},"section3":{"first":{"title":"Stethoscope Icon","text":"Content marked with the stethoscope icon is meant for your (HCP) reference only."}},"finish":"Let's get started"},"introduction":{"title":"Introduction","subtitle":"Why we are here today:","chronic":" Chronic lymphocytic leukemia (CLL) is an ongoing (chronic), slow-growing cancer of the blood","blood":" Blood tests and other symptoms (such as fatigue and swollen lymph nodes) have confirmed progression","monitored":"Your CLL is regularly monitored and may not have needed treatment","discuss":"Let's discuss the next steps together","ref":"CLL = chronic lymphocytic leukemia"},"discuss":{"subtitle":"Discuss your treatment journey and get ready to start treatment:","CLL":"CLL cannot be cured but it can be treated","treatment":" For many patients, CLL treatment can keep the disease under control for extended periods","lets":"So, let’s discuss what a CLL treatment plan is based on…","ref":"CLL = chronic lymphocytic leukemia."},"treatmentPlanBased":{"click":"Click to reveal","subheading":"Your CLL treatment plan is based on:","age":"Your age and fitness","ageText":" Certain treatment options might be preferred depending on your age and your fitness level.","health":"Your overall health:","options":" Certain treatment options might be preferred depending on other conditions you might have (for example, a condition affecting your heart or blood vessels).","type":" The type of CLL you have and some specific characteristics of your disease","genetics":" Cytogenetic testing can help determine your best treatment option. This could be done with a blood or a bone marrow sample","fish":" FISH testing shows whether your cancer cells have certain mutations (changes) in their genetic material (DNA). For this test, a blood sample is collected","optionsMore":"Treatment options:","because":"Because of these factors, ","certain":"certain","optionss":" treatment options may be better able to:","keep":"keep your CLL under control","reduce":"reduce your symptoms","ref":" CLL = chronic lymphocytic leukemia; FISH = fluorescent in situ hybridization; DNA = deoxyribonucleic acid. "},"ways":{"1":"1. A fixed duration (1 - 2 years), or","2":"2. An indefinite duration (as long as the medication is still effective for you), or","3":"3. Until your healthcare team tells you otherwise.","title":"Ways to Receive Your CLL Treatment","subtitle":"Let’s look at how you will receive your treatment","pills":"Pills (by mouth, at home)","atHome":"You will take your medication at home","mustTake":"You must take your medication ","exactly":"exactly","asTold":" as your pharmacist or doctor tells you","byMouth":" You will need to take your medication by mouth on an empty stomach or with food and at the correct dose","for":"You may need to take your medication for:","intra":"Intravenous (IV)","clinic":"You will go to a hospital or outpatient clinic","nurse":" A nurse will put an IV (a soft, flexible tube) into a vein in your chest or in your arm","tube":"You will be given your medication through the tube","hours":"It may take minutes to hours to receive your entire dose","return":" You will need to return several times over a few months","pharma":"As your medication may react with food, remember to talk to your pharmacist about when to take it","ref":"IV = intravenous."},"options":{"title":"Your Treatment Options","heading":"Let’s discuss which treatment options are available to you based on your health, your disease, and your genetic testing results:","subheading":"Genetic Testing Results","testing":"If your testing shows that your cancer cells have any of the following, a targeted therapy might be a good choice for you:","listItem1":"An unmutated IGHV gene (the gene is not changed compared to other cells in your body)","listItem2":"One of the following mutations (changes in your DNA):","del":"del(17p)","or":"or","tp":"TP53","footnote1":"CLL = chronic lymphocytic leukemia; del(17p) = 17p deletion; IGHV = immunoglobulin heavy chain gene; IV = intravenous;","nowrap1":" TP53 = tumour protein p53.","footnote2":"1. Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. 2. Stefaniuk P, et al.","italic1":"Cancer Management and Research.","footnote3":" 2021:13;1459-1476. Walewska R, et al.","italic2":"Br J Haematol.","footnote4":"2022;197(5):544-557."},"optionsBest":{"title":"Your Treatment Options","heading":"Let’s discuss which treatment options are available to you based on your health, your disease, and your genetic testing results:","optionsAre":"Your options for treatment are:","targeted":"Targeted therapies including:","other":"Other non-targeted options include:","chemo":"Chemo-immunotherapy","fcr":"FCR (fludarabine / cyclophosphamide / rituximab)","types":"Types of treatments","capsules":"Capsules","tablets":"Tablets","iv":"IV = intravenous;","injection":"Injection","approved":" †Acalabrutinib is also approved for use with obinutuzumab (Gazyva®), though this combination is only publicly funded in Quebec.","leukemia":"CLL = chronic lymphocytic leukemia;","del":"del(17p) = 17p deletion;","ighv":"IGHV = immunoglobulin heavy chain gene;","tp":"TP53 = tumour protein p53.","footnote1":"1. Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. 2. Stefaniuk P, et al.","italic":"Cancer Management and Research.","footnote2":" 2021:13;1459-1476","modal":{"title":"2022 CARE™ CLL Treatment Guidance"}},"optionsReview":{"title":"Review of Treatment Options","heading":"Let's review what we have learned:","progression":"Disease progression","stage":"At what stage is your cancer?","steps":"What are the next steps in your treatment journey?","types":"Types of treatments","ivOnly":"IV only","ivTablets":"IV and tablets/capsules","tabletsOnly":"Tablets/capsules only","availableOptions":"Your available treatment options","targeted":"Targeted therapies","or":"Or","chemo":"chemo-immunotherapy","fcr":"FCR (fludarabine / cyclophosphamide / rituximab)","point":"If you have any questions or would like to know more about anything you see here, please ask.","approved":"†Acalabrutinib is also approved for use with obinutuzumab (Gazyva®), though this combination is only publicly funded in Quebec.","footnote1":"FCR = fludarabine/cyclophosphamide/rituximab; IV = intravenous. 1. Hallek M, et al.","italic1":"Blood","footnote2":". 2018;131(25):2745-2760. 2. Acalabrutinib PM. 3. Ibrutinib PM. 4. Venetoclax PM. 5. Obinutuzumab PM. 6. Zanubrutinib PM. 7. Owen C, et al. ","italic2":"Curr Oncol","footnote3":". 2018 Oct;25(5):e461-e474."},"treatmentConsiderations":{"title":"Treatment Considerations","heading":"Today, you will find out about:","consider":"Things to consider for each treatment option, including","benefits":"Benefits and risks of each treatment","outcomes":"Outcomes of each treatment option","manage":"How to manage side effects","team":"How your healthcare team will follow up with you and will monitor you on your treatment journey","receive":"How and when you will receive your treatment","ways":"Extra ways to receive care and support on your treatment journey","point":"If you have any questions about what you learn today, you can write them down and bring them to your next appointment."},"optionsTabs":{"title":"Things to Consider for Your Treatment Options","learnAbout":"Let’s learn about the benefits and risks of ","learnAbout2":"Let’s learn about the benefits and risks of ","acala":{"ref1":"CLL = chronic lymphocytic leukemia; TLS = tumour lysis syndrome; 1. Acalabrutinib PM. 2. Byrd JC, et al. ","ital1":"J Clin Oncol","ref2":". 2021;39(31):3441-3452. 3. Owen C, et al. ","ital2":"Curr Oncol","ref3":". 2018 Oct;25(5):e461-e474."},"zanu":{"ref1":"CLL = chronic lymphocytic leukemia. 1. Tam CS, et al. ","ital1":"Lancet Oncol.","ref2":"2022;23:1031-1043."},"ibrutinib":{"ref1":"CLL = chronic lymphocytic leukemia; TLS = tumour lysis syndrome; 1. Ibrutinib PM. 2. Owen C, et al. ","ital1":"Curr Oncol.","ref2":" 2018 Oct;25(5):e461-e474. 3. Byrd JC, et al.","ital2":"J Clin Oncol.","ref3":" 2021;39(31):3441-3452."},"obinutuzumab":{"ref1":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al.","ital2":"J Clin Oncol.","ref3":" 2008;26(16):2767-2778."},"venetoclaxObinutuzumab":{"ref1":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al. ","ital2":"J Clin Oncol. ","ref3":"2008;26(16):2767-2778."},"venetoclax":{"ref1":"CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al. ","ital2":"J Clin Oncol. ","ref3":"2008;26(16):2767-2778."},"chemo":{"ref1":"CLL = chronic lymphocytic leukemia; FCR = fludarabine/cyclophosphamide/rituximab; IV = intravenous. 1. FCR_HEM_CLL.pdf. CCO Formulary August 2020. 2. Owen C, et al.","ital1":"Curr Oncol.","ref2":"2018;Oct;25(5):e461-e474. 3. Shadman M, et al. ","ital2":"JNCCN.","ref3":"2020;18(7.5):994-997. doi:10.6004/jnccn.2020.5011."},"venetoclaxIbrutinib":{"ref1":"CLL = chronic lymphocytic leukemia. 1. Kater AP, et al. ","ital1":"NEJIM Evid.","ref2":"2022;1:7. 2. Coiffer B, et al. ","ital2":"J Clin Oncol.","ref3":" 2008;26(16):2767-2778."}},"ossTabs":{"title":"Treatment Outcomes","learnAbout":"Let’s learn about the outcomes for each treatment","fourYears":"Four years","following":"after starting treatment, clinical trial researchers saw the following rates:","orr":"Overall response rate (ORR)","os":"Overall survival (OS)","pfs":"Progression-free survival (PFS)","more":"More data","definitions":{"def":"DEFINITION ","pfs1":"For patients who respond to treatment, this is the length of time before the cancer gets worse.","pfs2":"In a clinical trial, measuring PFS is a way to see how well a new treatment works.","pfsRef1":"1. National Cancer Institute. Available at:","pfsRefLink":"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/progression-free-survival.","pfsRef2":"Accessed March 15, 2022","orr1":" The percentage of people on a treatment who have a partial or complete response to the treatment within a certain period. A partial response means their tumour or tumours get smaller or in the amount of cancer in the body goes down. A complete response means that all signs of cancer in the body disappear.","orr2":" In a clinical trial, measuring the overall response rate is one way to see how well a new treatment works.","os1":" The length of time from either the date of cancer diagnosis or the start of cancer treatment that patients diagnosed with the disease are still alive.","os2":" In a clinical trial, measuring OS is a way to see how well a new treatment works.","osRef1":"1. National Cancer Institute. Available at:","osRefLink":"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/overall-survival.","osRef2":"Accessed March 15, 2022"},"zanu":{"twoYears":"Two years"},"ibru":{"six":"Six to seven years"},"ven":{"three":"Three to four years","noDifference":"No significant difference in OS","mayEndure":"Treatment response may endure","over":"Over 92%","patients":" of patients who were treated with ","didnot":"did not require","nextLine":" next-line therapy for ","threeOrMore":"3 or more years","after":" after treatment. Next-line therapy is given when a patient’s current treatment stops working"},"chemo":{"five":"Five years","following":"after starting treatment, clinical trial researchers saw the following rates in two types of chemo-immunotherapy (FCR and FC):","mutations":"If your CLL has no mutations in the IGHV gene or has del(17p) or TP53 mutations, chemo-immunotherapy may not be the best treatment option for you."},"venibru":{"learnAbout":"Let’s learn about the benefits and risks of ","three":"Three to four years","ref":" 1. Niemann CU, et al. Residual disease kinetics among patients with high risk factors treated with first line fixed duration ibrutinib plus venetoclax (Ibr+Ven) versus chlorambucil plus Obinutuzumab (Clb+O): the GLOW study. Presented at the American Society of Hematology Annual Meeting; December 10, 2022."},"refs":{"acala1":"*The rate for patients taking acalabrutinib+obinutuzumab was","acala2":"ORR = overall response rate; OS = overall survival; PFS = progression-free survival. 1. Sharman JP, et al. ","ital1":"Leukemia. ","acala3":"2022;36:1171-1175.","zanu1":"*The rate for patients with del(17p) was ","orr":"ORR = overall response rate;","os":"OS = overall survival;","pfs":"PFS = progression-free survival;","zan2":"1. Tam CS, et al. ","zanItal1":"Lancet Oncol.","zanu3":"2022;23:1031-1043.","ibru1":" *These benefits were similar in patients with high-risk CLL (TP53 mutation; unmutated IGHV disease but excluding del(17p)). CLL = chronic lymphocytic leukemia; del(17p) = deletion (17p); IGHV = immunoglobulin heavy chain gene; OS = overall survival; PFS = progression-free survival; TP53 = TP53 protein. 1. Barr PM, et al. ","ibruItal1":"Blood Adv.","ibru2":"doi:10.1182/bloodadvances.2021006434.","ven":" *CLL14 12-month fixed-duration VEN-OBI: 3+ YEAR FOLLOW-UP – OS and PFS were estimated to 4 years. CLL = chronic lymphocytic leukemia; OBI = obinutuzumab; OS = overall survival; PFS = progression-free survival. 1. Al-Sawaf O, et al. ","venItal1":"The Lancet Oncol.","ven2":"2020;21(9):P1188-P1200. doi:10.1016/S1470-2045(20)3043-5. 2. Al-Sawaf O, et al.","venItal2":"J Clin Oncol.","ven3":" 2021;39(36):4049-4060. doi:10.1200/JCO.21.01181. 3. Al-Sawaf O, et al. Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 4-year follow-up analysis of the randomized CLL14 study. Presented at the European Hematology Association Annual Meeting; June 11, 2021. ","chemo":" *CLL8 5.9-year Follow-up. †The OS rate of patients with mutations in the IGHV gene was 86% with FCR and 80% with FC after 5 years. CLL = chronic lymphocytic leukemia; del(17p) = deletion(17p); FC = fludarabine-cyclophosphamide; FCR = fludarabine-cyclophosphamide-rituximab; OS = overall survival; PFS = progression-free survival; TP53 = TP53 protein. 1. Fischer K, et al. ","chemoItal1":"Blood.","chemo2":" 2016;127(2):208-215. 2. Zenz T, et al. J Clin Oncol. 2010;28(29):4473-4479.","venibru":" 1. Niemann CU, et al. Residual disease kinetics among patients with high risk factors treated with first line fixed duration ibrutinib plus venetoclax (Ibr+Ven) versus chlorambucil plus Obinutuzumab (Clb+O): the GLOW study. Presented at the American Society of Hematology Annual Meeting; December 10, 2022. "}},"sideEffects":{"title":"Side Effects","what":"What is a side effect?","a":"A","treatment":"treatment side effect","is":"is a","symptom":"symptom","happens":"that happens due to a drug. Side effects may occur at any dose","know":" We know that these side effects can happen because of familiarity with these drugs","most":"Most","sideEffects":"treatment side effects","may":"may lessen after some time as your body becomes used to the medication","needed":" If needed, lowering the amount of medication you take or stopping the medication may reduce or stop the treatment side effect","discuss":"Always discuss discontinuing or lowering your dose with your doctor","first":"first","before":"before making any changes","lets":"Let’s discuss","so":", so you know:","expect":"What to expect during your treatment","how":"How to manage the side effects when/if they happen"},"sideEffectsTabs":{"title":"Side Effects","whatYouCanDo":" Here’s what you can do at home to try to prevent or manage certain side effects: ","tips":"Tips for Managing Your Side Effects","tipsAtHome":"Managing Side Effects at Home","monograph":"Product Monograph","very":"Very common","veryPeople":"50 or more out of 100 people","common":"Common","commonPeople":"25 to 49 out of 100 people","less":"Less Common","lessPeople":"10 to 24 out of 100 people","talk":"Talk to your doctor if you have any of these symptoms:","acala":{"tips":"","very":"Very common","captionVery":"50 or more out of 100 people","infections":"Infections*","common":"Common","people":"25 to 49 out of 100 people","bleeding":"Bleeding or bruising (common); low platelets in the blood (less common)","headache":"Headache","muscle":"Mild joint or muscle pain or cramps","diarrhea":"Diarrhea","less":"","lessPeople":"","lessList":{"nausea":"Nausea and throwing up (usually mild)","liver":" Liver problems","rash":"Rash and dry, itchy skin","tiredness":"Tiredness","low":"Low white blood cell counts","dizziness":"Dizziness","constipation":"Constipation","high":"High blood pressure","atrial":"Atrial fibrillation","cancer":"Cancer cells dying quickly when you start treatment (in severe cases TLS can happen, which may impact how well your organs work)"}},"tipsForHome":{"refs1":{"acala":"1. Acalabrutinib PM.","zanu":"1. Zanubrutinib PM.","ibru":"1. Ibrutinib PM.","ven":"1. Venetoclax PM.","chemo":"1. Rituximab PM. 2. Fludarabine PM."},"acala":{"toHelp":"To help prevent","infections":"infections","precautions":"Take certain precautions (eg, handwashing, mask wearing)","makeSure":"Make sure you and your close contacts are up - to - date on vaccinations","helpManage":"To help manage","headaches":"headaches","takeCaffeine":"Take caffeine (eg, coffee); if your headache doesn't go away, talk to your healthcare provider about medications you can take to manage your headache. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","aid":"To help manage","diarrhea":"diarrhea","increase":"Increase your intake of clear fluids (non-caffeinated, non-alcoholic, non-carbonated)","eatSmaller":"Eat smaller and more frequent meals consisting of low-fibre, high-calorie foods, like the BRAT (bananas, rice, applesauce, toast) diet ","avoid":"Avoid foods high in fat, sugar, and lactose, as well as acidic, spicy, or gas-producing foods","ask":"Ask your doctor about taking medications to help with diarrhea","helpManageAndPrevent":"To help manage and prevent","joint":"joint or muscle pain","talk":"Talk to your healthcare provider about medications you can take to manage your pain. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","stretching":"Do stretching and strengthening routines","apply":"Apply hot and/or cold compresses as needed","water":"Drink a lot of water","drinkTonic":"Drink tonic water in the evening to reduce muscle cramping at night","change":"Change your plans to lighten your load","ref1":"1. Banerji V, et al. Curr Oncol. 2020;27(6):e645-e655.","ref2":"2. Government of Canada. Immunization of immunocompromised persons: Canadian Immunization Guide. Dec 24, 2020. ","ref3":"3. Herishanu Y, Perry C. Blood. 2021;138(18):1652-1653.","ref4":"4. Diarrhea. Canadian Cancer Society website. ","link":"https://cancer.ca/fr/treatments/side-effects/diarrhea.","assessed":"Accessed April 29, 2022.","ref5":"5. Nierman P. Clin J Oncol Nurs. 2021;25(6):687-696.","ref6":"6. Cleveland Clinic website. Musculoskeletal Pain.","ref6Link":"https://my.clevelandclinic.org/health/diseases/14526-musculoskeletal-pain.","asessed6":"Accessed April 29, 2022. ","ref7":"7. Badillo M, et al. Clin J Oncol Nurs. 2022;24:392-398."},"zanu":{"toHelp":"To help prevent","infections":"infections","precautions":"Take certain precautions (eg, handwashing, mask wearing)","makeSure":"Make sure you and your close contacts are up - to - date on vaccinations","helpManage":"To help manage","headaches":"headaches","takeCaffeine":"Take caffeine (eg, coffee); if your headache doesn't go away, talk to your healthcare provider about medications you can take to manage your headache. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","aid":"To help manage","diarrhea":"diarrhea","increase":"Increase your intake of clear fluids (non-caffeinated, non-alcoholic, non-carbonated)","eatSmaller":"Eat smaller and more frequent meals consisting of low-fibre, high-calorie foods, like the BRAT (bananas, rice, applesauce, toast) diet ","avoid":"Avoid foods high in fat, sugar, and lactose, as well as acidic, spicy, or gas-producing foods","ask":"Ask your doctor about taking medications to help with diarrhea","helpManageAndPrevent":"To help manage and prevent","joint":"joint or muscle pain","talk":"Talk to your healthcare provider about medications you can take to manage your pain. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","stretching":"Do stretching and strengthening routines","apply":"Apply hot and/or cold compresses as needed","water":"Drink a lot of water","drinkTonic":"Drink tonic water in the evening to reduce muscle cramping at night","change":"Change your plans to lighten your load"}},"zanu":{"lowSugar":"Low blood sugar*","lowBlood":"Low blood cell counts*","muscle":"Muscle or joint pain*","upper":"Upper respiratory tract infection*","bleeding":"Bleeding*","rash":"Rash*","bruising":"Bruising","abnormalKidney":"Abnormal kidney lab tests*","abnormalLiver":"Abnormal liver lab tests*","cough":"Cough","highBlood":"High blood pressure*","diarrhea":"Diarrhea*","pneumonia":"Pneumonia*","tiredness":"Tiredness*","another":"Another type of cancer*","headache":"Headache","dizziness":"Dizziness*","constipation":"Constipation*","nausea":"Nausea","atrial":"Atrial fibrillation†"},"ibru":{"higher":"Higher than normal white blood cell counts","diarrhea":"Diarrhea","headache":"Headache","muscle":"Mild joint or muscle pain or cramps","tiredness":"Tiredness","high":"High blood pressure","low":"Low appetite (not wanting to eat)","cough":"Cough and feeling short of breath","nausea":"Nausea and throwing up","rash":"Rash and dry, itchy skin","swelling":"Mild swelling","eye":"Eye problems*","constipation":"Constipation","infections":"Infections (incl. pneumonia, skin infections)","lowWhite":"Low white blood cell counts*","atrial":"Atrial fibrillation"},"ven":{"low":"Low white blood cell counts*","platelets":"Low platelets in the blood*","allergic":"Allergic reaction*","diarrhea":"Diarrhea","nausea":"Nausea and throwing up (usually mild)","tiredness":"Tiredness","headache":"Headache","mild":"Mild joint or muscle pain or cramps","fever":"Fever, chills, infection*","liver":"Abnormal liver lab tests*","kidney":"Abnormal kidney lab tests*","bleeding":"Bleeding*","cough":"Cough and feeling short of breath","swelling":"Mild swelling","cramps":"Pain or cramps in the belly","rash":"Rash and dry, itchy skin","salt":"Too much or too little salt in your body","constipation":"Constipation","dizinness":"Dizziness","mouth":"Mouth sores","tls":"TLS (cancer cells dying quickly when you start treatment, which might impact how well your organs work)"},"chemo":{"one":"Myelosuppression (when fewer blood cells are made) with or without bleeding","infection":"Infection","nausea":"Nausea/throwing up, diarrhea, refusing to eat","fever":"Fever","liver":"Abnormal liver lab tests","tiredness":"Tiredness","rash":"Rash*","vision":"Changes in vision","bladder":"Inflamed bladder","fertility":"Risk to fertility and the ability to have children","autoimmune":"Autoimmune disorders","brain":"Encephalopathy (a brain disorder), seizures, feeling confused or agitated","lungs":"Inflamed lungs","heartFailure":"Heart failure, irregular heartbeat","clots":"Blood clots","siadh":"SIADH (a disorder that causes too little salt in the body)","dic":"DIC (a disorder of the proteins that help blood to clot)","cancer":"Developing a secondary cancer","vod":"VOD, HUS (disorders affecting blood flow to the liver and kidneys)","tls1":"Tumour lysis syndrome (TLS; TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work)","kidney":"Kidney failure","pancreas":"Inflamed pancreas","rhab":"Rhabdomyolysis (a syndrome where muscles break down)","graft":"Transfusion-associated graft-versus-host disease (when transfused blood components attack the patient’s body due to chemotherapy’s immune effects)","bleeding":"Bleeding issues","heartIssues":"Heart issues (including irregular heartbeat, chest pain)","weakness":"Weakness, memory problems, changes in vision, mood changes, loss of speech, numbness","hepat":"Hepatitis B infection","shingles":"Shingles","infusion":"Infusion-related reactions (fever and chills, nausea, throwing up, skin rash, swelling, difficulty breathing)","redness":"Redness, blisters on skin and/or mouth","kidneyProblems":"Kidney problems (may see swelling, side/back pain)","tls":"TLS"},"refs":{"maybe":"*May be severe","less":"†Less common than 10%","tls":"TLS = tumour lysis syndrome; PM = product monograph","cancerCare":"1. Cancer Care Ontario. Acalabrutinib – Patient Info Sheet. Available at:","cancerCareLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/63766.","assessed":"Accessed March 15, 2022. 2. Coiffer B, et al. ","oncol":"J Clin Oncol.","oncol2":" 2008;26(16):2767-2778.","acala":"3. Acalabrutinib PM. 4. Byrd JC, et al. ","lancet":"Lancet Oncol.","acala2":"2021;39(31):3441-3452.","zanu":"1. BRUKINSA PM. 2. Tam CS, et al. ","zanu2":"2022;23:1031-1043.","pm":"PM = product monograph.","ibru":"1. Cancer Care Ontario. Ibrutinib –Patient Info Sheet. Available at:","ibruLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44366.","ibruAcessed":"Accessed: March 15, 2022. 2. Ibrutinib PM.","obinu":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","obinu2":" 2020;21(9):1188-1200. 4. Coiffer B, et al.","obinu3":"2008;26(16):2767-2778.","venTLS":"TLS = tumour lysis syndrome","ven1":" 1. Cancer Care Ontario. Venetoclax –Patient Info Sheet. Available at:","venLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44476.","venAssessed":" Accessed: March 15, 2022. 2. Cancer Care Ontario. Obinutuzumab –Patient Info Sheet.","venLin2":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44386.","venAssessed2":"Accessed: March 15,2022. 3. Coiffer B, et al.","ven3":"2008;26(16):2767-2778.","chemo1":" CNS = central nervous system; DIC = disseminated intravascular coagulation; FC = fludarabine/cyclophosphamide; HUS = hemolytic uremic syndrome; SIADH = syndrome of inappropriate antidiuretic hormone; TLS = tumour lysis syndrome; VOD = veno-occlusive disease.","cancerCareFC":"1. Cancer Care Ontario FC Regimen","chemo2":"https://www.cancercareontario.ca/en/system/files_force/FC_HEM_CLL.pdf?download=1.","chemoAssessed":"Accessed: March 15, 2022. 2. Rituximab Product Monograph 3. Coiffer B, et al.","chemo3":"2008;26(16):2767-2778.","venibru":" CLL = chronic lymphocytic leukemia. 1. Kater AP, et al.","evid":"NEJIM Evid.","venibru2":"2022;1:7. 2.","veinbru3":" Coiffer B, et al.","veinbru4":"2008;26(16):2767-2778.","obinuModal":{"ref1":"1. Cancer Care Ontario. Obinutuzumab –Patient Info Sheet. Available at:.","ref1Asessed":"Accessed : March 15, 2022."},"venibruModal":{"pms":"1. VENCLEXTA PM. 2. IMBRUVICA PM. 3. KaterAP, et al."}}},"dosing":{"title":"Dosing","keep":"As you receive your treatment, here are some things your healthcare providers and you need to keep in mind:","acala":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":"Take your acalabrutinib tablets exactly as your healthcare professional tells you. If you are on 2 tablets a day, take them about 12 hours apart","same":"Take about the same time each day","with":"Take with or without food","swallo":" Swallow them whole with a glass of water. Do not chew, crush, dissolve, or divide the tablets","bold1":"Do not","takeCertain":" take certain medications called strong or moderate CYP3A4 and/or CYP3A4 inducers. A few examples are:","inhibitors":"Inhibitors: Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","inducers":" Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","discuss":" Discuss with your doctor the benefits and risks of stopping acalabrutinib for at least 3 days before and after having surgery","talk":"Talk to your healthcare provider if you have","bleeding":"bleeding problems, or before you plan on taking medicines that may increase your risk of bleeding,","including":"including:","aspirin":"aspirin and anti-inflammatories such as ibuprofen or naproxen","thinners":"blood thinners such as warfarin, heparin or other medicines to treat or prevent blood clots such as dabigatran, rivaroxaban, apixaban","supplements":"supplements such as fish oil, vitamin E and flaxseed"},"zanu":{"take":"Take your zanubrutinib capsules exactly as your healthcare professional tells you.","swallow":"Swallow them whole with a glass of water. Do not open, break, or chew the capsules","bold1":"Do not","takeCertain":"take certain medications called strong or moderate CYP3A4","inducers":"inducers.","examples":"A few examples are:","gloc":"Some glucocorticoids, anti-seizure medications, St. John’s Wort","caution":"Take caution","strong":" with certain medications called strong or moderate CYP3A","inhibitors":"inhibitors","doctor":". Your doctor will give you a lower dose of zanubrutinib. A few examples are:","antifungals":" Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","discuss":"Discuss with your doctor the benefits and risks of stopping zanubrutinib for at least 3 days before and after having surgery","talk":"Talk to your healthcare provider if you have","bleeding":" bleeding problems, or before you plan on taking medicines that may increase your risk of bleeding,","including":" including:","aspirin":"aspirin and anti-inflammatories such as ibuprofen or naproxen","thinners":" blood thinners such as warfarin, heparin or other medicines to treat or prevent blood clots such as dabigatran, rivaroxaban, apixaban","supplements":"supplements such as fish oil, vitamin E and flaxseed"},"ibru":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":" Take your ibrutinib capsules by mouth once per day","swallow":" Swallow them whole with a glass of water","donot":" Do not open, crush, or chew the capsules","takeSame":" Take your ibrutinib capsules at about the same time each day","bold1":"Do not","grape":"take your ibrutinib capsules with grapefruit juice or fish oils","strong":" take certain medications called strong CYP3A4","inhibitors":" inhibitors","and":"and/or CYP3A4","inducers":" inducers","examples":". A few examples are:","inhibitorsEx":" Inhibitors: Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","inducersEx":" Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","if":" If you have moderate or severe liver problems, you should not take ibrutinib","let":"Let your healthcare provider know if","unusual":" you have unusual bleeding or bruising or plan on taking any medicines that may increase your risk of bleeding,","such":" such as:","aspirin":" Aspirin, anti-inflammatories (e.g., ibuprofen, naproxen, and others), warfarin, heparin, other medications to prevent or treat blood clots (e.g., dabigatran, rivaroxaban, apixaban), or any supplements that increase your risk of bleeding such as fish oil, flaxseed, or vitamin E","discuss":"Discuss with your doctor the benefits and risks of stopping ibrutinib at least 3 days before and after surgery"},"ven":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","while":" While receiving venetoclax treatment, you are at risk of developing tumour lysis syndrome (TLS). TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work, and requires hospitalization","when":" When you first start your venetoclax treatment, you need to be monitored closely in hospital with frequent blood work to look for signs of TLS","healthcare":"Your healthcare team will assess your risk of TLS","if":"If you are prescribed allopurinol, it is important to stay hydrated","should":"You should receive obinutuzumab as an","iv":"IV infusion only","shouldReceive":" You should receive 9 infusions in a hospital or other location where equipment is available for life-saving action in the event of an emergency","doctor":"An experienced doctor should care for you or supervise your care","infusion":"Obinutuzumab infusions should","not":"not","beGiven":" be given too quickly (this is called a bolus or push)","kidney":"If you have kidney problems, you may experience more side effects. These side effects could include TLS"},"chemo":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","usually":" Usually, you will receive a total of six (6) chemotherapy cycles unless your cancer gets worse, or the side effects become too difficult for you","if":" If your blood test results show that your white blood cell and platelet counts are too low after one cycle, your next cycle may start one week later than scheduled","if2":" If your blood tests continue to show low white blood cell and platelet counts, or you develop a major infection, your dose of two of your chemotherapy drugs (fludarabine and cyclophosphamide) will be lowered","if3":"If you are at a higher risk for tumour lysis syndrome (TLS), you will take another medication to help prevent TLS.","if4":"TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","treatment":" Your treatment may be different based on your age and on your genetic testing results","not":"Chemo-immunotherapy with FCR is not recommended for patients with ","del":"del(17)p","mutations":"mutations","instead":"Instead, the recommended treatments to start with are:","acala":"Acalabrutinib ± obinutuzumab","ibru":"Ibrutinib","ven":"Venetoclax + obinutuzumab"},"obinu":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","should":"You should receive obinutuzumab as an","iv":"IV infusion only","shouldReceive":" You should receive it in a hospital or other location where equipment is available for life-saving action in the event of an emergency","obinuShould":"Obinutuzumab infusions should","not":"not","beGiven":"be given too quickly (this is called a bolus or push)","kidney":" If you have kidney problems, you may experience more side effects, which could include tumour lysis syndrome (TLS; TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work)"},"venibru":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":"Take your ibrutinib capsules by mouth once per day ","swallow":"Swallow them whole with a glass of water","donot":" Do not open, crush, or chew the capsules","takeSame":"Take your ibrutinib capsules at about the same time each day","bold1":"Do not","grape":"take your ibrutinib capsules with grapefruit juice or fish oils","strong":" take certain medications called strong CYP3A4","inhibitors":" inhibitors","and":"and/or CYP3A4","inducers":" inducers","examples":". A few examples are:","inhibitorsEx":"Inhibitors: Certain antifungals, antibiotics, blood pressure medications, grapefruit juice","inducersEx":"Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","if":" If you have moderate or severe liver problems, you should not take ibrutinib","while":"While receiving venetoclax treatment, you are at risk of developing tumour lysis syndrome (TLS). TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work, and requires hospitalization","when":"When you first start your venetoclax treatment, you need to be monitored closely in hospital with frequent blood work to look for signs of TLS","healthcare":"Your healthcare team will assess your risk of TLS"},"refs":{"acala1":"CYP3A4 = cytochrome P450 3A4; IV = intravenous; PPI = proton pump inhibitors;","acala2nowrap":"TLS = tumour lysis syndrome.","acala3":"1. Acalabrutinib PM.","acala4":"2. Obinutuzumab PM. 3. Coiffer B, et al.","acalaItal":"J Clin Oncol.","acala5":"2008;26(16):2767-2778.","zanu":"CYP3A4 = cytochrome P450 3A4. 1. BRUKINSA PM.","ibru":"CYP3A4 = cytochrome P450 3A4; PM = product monograph. 1. Ibrutinib PM.","ven1":" IV = intravenous; PM = product monograph; TLS = tumour lysis syndrome. 1. Venetoclax PM.","ven2":" 2. Obinutuzumab PM. 3. Coiffer B, et al.","venItal":"J Clin Oncol.","ven3":"2008;26(16):2767-2778.","chemo1":"del(17p) = deletion 17p; FCR = fludarabine/cyclophosphamide/rituximab;","chemo2nowrap":"TLS = tumour lysis syndrome.","chemo3":"1. Cancer Care Ontario. FC+R Regimen. August 2020.","chemo4break":"https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf.","chemo5":"Accessed Feb 8, 2022.","chemo6":" 2. Kotiah SD, et al. Drugs & Diseases. Accessed February 8, 2022.","chemo7break":"https://emedicine.medscape.com/article/2005390-overview.","chemo8":"3. Coiffer B, et al. J Clin Oncol. 2008;26(16):2767-2778."}},"schedule":{"title":"Treatment Schedule","lets":"Let’s compare the schedules for each treatment choice.","calendar":" This calendar shows when you will receive your medication.","calendars":"These calendars show when you will receive your medications.","available":"Available as an outpatient prescription, which means you take it at home","morning":"Morning","everyDay":"every day","evening":"Evening","once":"Once","or":"or","everyDay2":"every day","continueUntillDifficult":"Continue taking it unless your cancer gets worse or the side effects become too difficult for you","another":"Another treatment may be required","nausea":"for nausea or throwing up","if":"If you experience nausea and vomiting, your doctor may prescribe you a medication (an antiemetic) to help manage these symptoms","risk":"If you are at risk for a side effect called tumour lysis syndrome (TLS), your physician will monitor you closely and may decide to give you a treatment to help prevent it","tls":"TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","infections":"If you are at risk for certain infections, your physician may decide to give you a treatment to help prevent them","day12815":"Day 1, 2, 8, 15","atleast4":"(at least 4 hours for infusion)","day22":"Day 22","start":"Start ramp-up","dose":"Dose increases weekly until week 5","day1":"Day 1","everyCycle":"every cycle;first cycle will be lower dose (4 hours for infusion)","everyCycle2":"every cycle","EveryDay":"Every day","takenFor5":"Taken on Day 1 for 5 cycles (6 total)","continue12thCycle":"Continue until the end of the 12th cycle unless your cancer gets worse or the side effects become too difficult for you","continue15thCycle":"Continue until the end of the 15th cycle unless your cancer gets worse or the side effects become too difficult for you","startUntill5":"Start ramp-up dose increases weekly until week 5","cycle1IV":"Cycle 1 given by IV, cycles 2–6 given by a needle (subcutaneously [under the skin])","day12345":"Day 1, 2, 3, (4 & 5)","mostTake":"Most patients take this medication on days 1–3 of each cycle, while some take it on days 1–5","ifReq":"If required","forNausea":"for nausea or throwing up","forTLS":"for TLS and infection prevention","monitor":"Your healthcare team will monitor you closely to help prevent tumour lysis syndrome (TLS).","tlsCanHappen":" TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","note":"Note: This is an example of how you may receive this treatment. A doctor who is trained in the use of chemotherapy will give this treatment. ","mayAdjust":"They may adjust the treatment depending on how your body tolerates the medications.","ref1":"IV = intravenous; PM = product monograph. 1. Acalabrutinib PM. 2. Obinutuzumab PM.","ref1Zanu":"PM = product monograph. 1. BRUKINSA PM.","ref2":"PM = product monograph; TLS = tumour lysis syndrome. 1. Ibrutinib PM. 2. Cancer Care Ontario. IBRU Regimen. ","ref2Link":"https://www.cancercareontario.ca/sites/ccocancercare/files/IBRU_HEM_CLL.pdf.","ref2Assessed":"Accessed: February 8, 2022.","ref3":"3. Coiffer B, et al. ","ref3Ital":"J Clin Oncol.","ref3cont":"2008;26(16):2767-2778.","ref4":"VEN = venetoclax. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Fischer K, et al.","ref4ital":"N Engl J Med.","ref4cont":"2019;380:2225-2236. 4. Cancer Care Ontario. VENE+OBIN Drug Formulary.","ref4Link":"https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/62876.","ref4accessed":"Accessed: Feb 7, 2022.","ref5chemo":"IV = intravenous; PM = product monograph; TLS = tumour lysis syndrome. 1. Cancer Care Ontario. FC+R Regimen. August 2020.","ref5chemoLink":" https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf. ","ref5chemoAssessed":" Accessed Feb 8, 2022. 2 Rituximab PM. 3. Coiffer B, et al. J Clin Oncol. 2008;26(16):2767-2778."},"logistics":{"title":"Logistics for Receiving Your Treatment","gettingToHospital":"Getting to the hospital/infusion centre","IVsupport":"Support for IV infusion visits","multipleVisits":"Multiple healthcare provider visits","waitTimes":" Wait times for infusions and hospital beds","doctorWillMonitor":" Your doctor will need to monitor you (in-person) for some side effects","addmitted":"May need to be admitted to the hospital for TLS due to venetoclax","addmittedChemo":"May need to be admitted to the hospital for TLS due to chemo","eachCycle":"*Each cycle is 28 Days","waitTimes2":"Wait times for infusions / hospital beds","ivTLS":" IV = intravenous; TLS = tumour lysis syndrome."},"funding":{"title":"Funding for Previously Untreated CLL by Province","approval":"Health Canada Approval","recommendation":"Recommendation","NIHB":"NIHB","reimburseCond":"Reimburse with clinical criteria and/or conditions","underReview":"Under reimbursement review","refa":" a For the treatment of patients with previously untreated CLL for whom a fludarabine-based regimen is inappropriate.","refb":"b First-line tx of pts with CLL and a CIRS ≤6.","refc":"c ± Obinutuzumab","refd":"d Limited use benefit (prior approval required).","cirs":" CIRS = cumulative illness rating scale;","cll":" CLL = chronic lymphocytic leukemia;","nihb":" NIHB = Non-Insured Health Benefits Program;","pts":" pts = patients; tx = treatment.","link1":"1. https://www.cadth.ca/reimbursement-review-reports.","link2":"2. https://www.lymphoma.ca/wp-content/uploads/2020/12/CLL-SLL-Provincial-Drug-Funding-Table.pdf.","link3":" 3. https://www.canada.ca/en/indigenous-services-canada/search/advanced-search.html;"},"summaryQuestions":{"title":"Summary Questions to Ask","lets":" Let’s review the following questions to make sure you and your caregiver(s) understand what was discussed","believe":" Do you believe that you have a good understanding of the Treatment Options available to treat your CLL?","areyou":"Are you and your caregiver(s) satisfied that you have enough information to select a treatment option if not today, then at the next visit?","support":"Do you believe that your support team understands how they may help you once you start your treatment journey?","other":"Are there any other questions that you would like to ask me today?","think":"If you think of any questions regarding your treatment journey,","write":"please write them down","discuss":" we will discuss them next time."},"trialSummaries":{"title":"Clinical Trial Summaries","treatment":"Treatment","name":"Trial name","design":"Trial design","population":"Population","outcomes":"Primary outcomes","secondary":"Select secondary outcomes","safety":"Safety","other":"Other safety comments","elevate5follow":"ELEVATE-TN 5-Yr Follow-up","acalobin":"ACAL ±OBIN vs OBIN + Clb","phase3":"Phase 3, multi-centre,","openLabel":"open label","ptsAged":"Pts aged ≥65 years or","crcl":"18-64 years with CrCl< 70 mL and/or CIRS-G score >6","medianPFS":"Median PFS:","nrao":"NR (A + O) vs NR (A) vs 27.8 mos (O + Clb) (","P":"P","<0":"<0.0001)","estPFS60":"Est. PFS at 60 mos:","84%":"84% (A + O) vs 72% (O)","vs21%":"vs 21% (O + Clb)","estimatedOS60":"Estimated OS at 60 mos: ","90%ao":"90% (A + O) vs 84% (A), vs 82% (O + Clb)","odr":"ODR:","35%ao":"35% (A + O), 40% (A), and 23% (O + Clb)","mostCommonReasons":"Most common reasons:","AEs":"AEs: (17% [A + O], 16% [A], 14% [O + Clb])","pdao":"PD: (6% [A + O], 10%[A], 2% [O + Clb])","safetyAO":"Safety of A + O and A mono-therapy maintained","ibru":"I = ibrutinib;","resonate2":"RESONATE 2","8yrFollowUp":"8-Yr Follow-up","ibrVSclb":"IBR vs Clb","phase3RCT":"Phase 3, RCT, double-blind, multi-centre, open label","ptsAged65":"Pts aged ≥65 years","without":"without","del(17p)":"del(17p)","neVS15":"NE vs 15.0 mos (HR 0.16; 95% CI .11-0.23)","estPFSat7yrs":"Est. PFS at 7 years:","59%I":"59% (I) vs 9% (Clb)","estOSibr":"Est. OS for IBR at 7 years:","78%":"78%","grade>3":"Grade ≥3 infectious complications:","hyper12%":"Hypertension: 12% Afib: 6%","grade>3hemor":"Grade ≥3 major hemorrhage: 7%","8yrFollow":"8-year follow-up:","noSafetySignals":"no new safety signals","alliance":"ALLIANCE A041202","ibr+rtx":"IBR + RTX vs. BEN + RTX","phase3RCTsolo":"Phase 3, RCT","reachedOnlyBen":"reached only with BEN + RTX","est24mPFS":"Est. 24-mos PFS:","74%brI":"74% (BR) vs 87% (I) vs 88% (I+R)","os":"OS:","noSigDifference":"No significant difference among the three treatment groups","grade3hema":"Grade ≥3 hematologic AEs:","61BRI":"61% (BR) vs 14% (I)","vs39":"vs 39% (I+R)","grade3nonhema":"Grade ≥3 nonhematologic AEs","63%BRIbru":": 63% (BR) vs 74% (I/I+R)","n/a":"N/A","iLL":"iLLUMINATE","ibrObi":"IBR + OBI vs Clb+ OBI","phase3RCTmulti":"Phase 3, RCT, multi-centre, open label","ptsAged65orComor":"Pts aged ≥65 years or < 65 years with comorbidities*","cirs6":"*CIRS > 6, CrCl< 70 mL/min, and/or","deltp53":"del(17p)/TP53","mut":"mut","nr":" NR vs 19.0 mos (HR 0.23; 95% CI 0.15-0.37;","<0.01":"<0.001)","est30m":"Est. 30-mos PFS:","79%vs31%":"79% vs 31%","pfsInHighRisk":"PFS in high-risk patients: ","nrVS14":"NR vs 14.7 mos (HR 0.15; 95% CI 0.09-0.27; ","osRate30":"OS rate at 30 mos:","86vs85":"86%vs 85%","mostCommonGrade":"Most common grade 3/4 AEs:","neutrop":"Neutropenia & thrombocytopenia","saes58":"SAEs: 58% vs 35%","trd":"Treatment-related deaths: ","1bothArms":"1% in both arms","ecog":"ECOG-ACRIN E1912","ibr":"IBR + RTX vs FCR","phase3RCTopen":"Phase 3, RCT, multi-centre, open label","ptsAged70":"Pts aged ≤ 70 years","stratified":"Stratified according to age, ECOG-PS, Rai stage and","del11q23":"del11q23","presenceabsence":"presence/absence","exclusions":"Exclusions: Pts with","del(17)p":"del(17p)","pfsAt3yrs":"PFS at 3-yrs:","89vs73":" 89% vs 73% ","hr035":"(HR 0.35; 95% CI 0.22-0.56;","os3ys":"OS at 3-yrs:","99vs92":"99% vs. 92%","hr017":"(HR 0.17; 95% CI 0.05-0.54;","grade3AEs":"Grade ≥3 AEs:","80%bothArms":"80% in both arms","11vs20":"11% vs 20% (","ven":"Venetoclax","plusobinu":"(+ obinutuzumab)","cll14":"CLL14","5ysFollowUp":"5-Yr Follow-up","vene":"VENE + OBIN vs Clb+ OBIN","phase3MultiCenter":"Phase 3, multi-centre,","openlabel":"open label","ptsWithUntreated":"Pts with previously untreated CLL and coexisting medical conditions (CIRS > 6 and/or CrCl< 70 mL/min)","estPFS5ys":"Est. PFS at 5 years:","62vs27":" 62.6% vs 27.0% (HR0.35; 95% CI 0.26-0.46,","<0.0":"<0.0001)","estOS5ys":"Est. OS at 5 years:","88vs77":"88.9% vs 77.0% (HR 0.72; 0.48-1.09,","=0.12":"=0.12)","mostFrGrade":"Most frequent grade 3/4 AE:","neutropeniaVEN":"Neutropenia (52% [VENE + OBIN] vs 47% [Clb+ OBIN])","patientsWithAtLeast1":"Number of patients with at least 1 SPM:","21VenVS15":"21% (VENE + OBIN) vs 15% (Clb+ OBIN) = NS","all-case":"All-cause mortality:","9%vene":"9% (VENE+ OBIN) vs. 8%","clbObin":"(Clb+ OBIN) = NS","acala":"A = acalabrutinib;","acalal":"ACAL = acalabrutinib;","ben":"BEN = bendamustine;","br":"BR = bendamustine + rituximab;","celsius":"C = celsius;","ci":"CI = confidence interval;","cirs-g":"CIRS-G = Cumulative Illness Rating Scale –Geriatric;","clb":"Clb = chlorambucil;","cll":"CLL = chronic lymphocytic leukemia;","CrCL":"CrCl = creatinine clearance;","delpdef":"del(17p) = deletion 17p;","cgdef":"COG = Eastern Cooperative Oncology Group scale;","estdef":"est = estimated;","F":"F = fahrenheit;","HR":"HR = hazard ratio;","word":"IBR = ibrutinib;","mosdef":"mos = months;","NEdef":"NE = not estimated;","nrdef":"NR = not reached;","obinu":"O = obinutuzumab;","obinubi":"OBI = obinutuzumab;","osdef":"OS = overall survival;","pfsdef":"PFS = progression-free survival;","ptsdef":"Pts = patients;","rtxdef":"RTX = rituximab;","spmdef":"SPM = second primary malignancy;","venedef":"VENE = venetoclax;","ydef":"y = year;","yrdef":"Yr = year. 1. Sharman JP, et al. American Society of Clinical Oncology (ASCO) Annual","ref1":"Meeting; June 2-6, 2021. Poster #7539. 2. Barr PM, et al. American Society of","ref2":"Clinical Oncology (ASCO) Annual Meeting; June 4-8, 2021 (ASCO Virtual Meeting).","ref3":"Poster# 7523. 3. Woyach JA, et al.","engl":"N Engl J Med","ref4":". 2018;379(26):2517-2528. 4. Moreno C, et al.","oncol":"The Lancet Oncol","ref5":". 2019;20(1):P43-P56. 5. Shanafelt TD, et al.","ref6":". 2019;381:432-443. 6. Fischer K, et al.","ref7":". 2019;380:2225-2236."},"trialSummariesCont":{"glow4yr":"GLOW 4-Yr Follow-up","estPFS42":"Est. PFS at 42 mos:","ptsAged65":"Pts aged ≥65 years or 18-64 years with CrCl< 70 mL or CIRS >6","ptsAged65Comor":"Pts aged ≥65 years or 18-64 years with comorbidities and CrCl< 70 mL or CIRS >6","nrvi":"NR (V + I) vs 21.0 mos (O + Clb) (","nrz":"NR (Z) vs 28.1 mos (B + R) (","p":"P","75vi":"75% (V + I) vs 25% (O + Clb)","<001":"<0.001)","<0001":"<0.0001)","estPFS24":"Est. PFS at 24 mos:","85zbr":"85.5% (Z) vs 69.5% (B + R)","estOS42":"Estimated OS at 42 mos:","osVI88":"88% (V + I) vs 78% (O + Clb)","estOS24":"Estimated OS at 24 mos:","94zvs94br":"94.3 (Z) vs 94.6% (B+R)","grad34ae":"Grade 3/4 AEs:","neutropenia11z":"Neutropenia (11% [Z] vs 51% [B + R])","hypertension":"Hypertension (6% [Z] vs 5% [B + R])","cardiac":"All cardiac AEs (4% [Z]","vs4":"vs 4% [B + R])","aeDeath":"AE leading to death:","neutropenia34":"Neutropenia (34.9% [V + I] vs 49.5% [O + Clb])","infections15":"Infections (15.1% [V + I] vs 10.5% [O + Clb])","hyper75":"Hypertension (7.5% [V + I] vs 1.9% [O + Clb])","atrial6":"Atrial fibrillation (6.6% [V + I] vs 0% [O + Clb])","11inZ":"11 in Z arm and 12 in B + R arm","relatedDeaths":"Treatment-related deaths:","moreDeaths":"more deaths during","randomizedTreatment":"randomized treatment in","viArms":"V + I arm vs O + Clb arm","note":"Note: Cross-comparisons between treatment studies should not be inferred.","ae":" AE, adverse event;","bben":" B/BEN, bendamustine;","clb":" Clb, chlorambucil;","cirs":" CIRS, Cumulative Illness","rating":" Rating scale CrCl = creatinine clearance; ","iibr":" I/IBR, ibrutinib; ","mo":" mo = month; ","nr":" NR, not reached; ","oobin":" O/OBIN = obinutuzumab; ","os":" OS, overall survival; ","pfs":" PFS, progression-free survival;","pt":" Pt, patient; ","rrtx":" R/RTX, rituximab; ","vven":" V/VEN = venetoclax; ","yr":" Yr = year; ","zan":"Z/ZAN, zanubrutinib.","ref1":"1. Niemann C, et al. ASH Annual Meeting; December 10-13, 2022; Abstract #93. 2. Tam C, et al.","oncol":"Lancet Oncol.","ref2":"2022;23(8):P1031-1043."},"summary":{"title":"Patient Resources (Saved Pages)","email":"Email","print":"Print","printNote":{"bold":"When printing:","text":"Please note that only the content currently displayed on the screen below will print. Ensure your preferred content is selected before printing."},"scan":"Scan QR code for saved summary pages","encouraged":"You are encouraged to share these resources with your caregivers","ifyoudlike":"If you would like to include all of the content for a particular agent, please select your agent(s) of interest below:"},"references":{"title":"References","cancerCare":" Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. Accessed December 18, 2021.","options":"StefaniukP, et al. Therapeutic Options for Patients with TP53 Deficient Chronic Lymphocytic Leukemia: Narrative Review.","cancerMgmt":"Cancer Management and Research","cancerMgmtCont":". 2021;13;1459-1476.","hallekM":"HallekM, et al. iwCLLguidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL.","blood":"Blood","hallekMCont":". 2018;131(25):2745-2760.","azPM":" AstraZeneca Canada Inc. Calquence (Acalabrutinib) Product Monograph.","azPMLink":"https://www.astrazeneca.ca/content/dam/az-ca/downloads/productinformation/calquence-product-monograph-en.pdf.","azPMassessed":" Accessed January 4, 2022.","byrd":"Byrd JC, et al. Acalabrutinib Versus Ibrutinib in Previously Treated Chronic Lymphocytic Leukemia: Results of the First Randomized Phase III Trial.","jclinoncol":"J Clin Oncol","byrdCont":". 2021;39(31):3441-3452.","coiffer":"Coiffer B, et al. Guidelines for the Management of Pediatric and Adult Tumor Lysis Syndrome: An Evidence-Based Review.","coifferCont":". 2008;26(16):2767-2778.","owenC":"Owen C, et al. Canadian evidence-based guideline for the first-line treatment of chronic lymphocytic leukemia.","currOncol":"CurrOncol","owenCcont":". 2018;25(5):e461-e474.","roche":" Roche Canada. Gazyva (Obinutuzumab) Product Monograph. https://www.rochecanada.com/PMs/Gazyva/Gazyva_PM_E.pdf. Accessed January 28, 2022.","sharman":"Sharman JP, et al. Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial.","lancet":"Lancet","sharmanCont":". 2020;395(10232):1278-1291.","janssen":" Janssen Inc. Imbruvica (Ibrutinib) Product Monograph. https://pdf.hres.ca/dpd_pm/00046525.PDF. Accessed January 28, 2022.","abbVie":" AbbVie Corporation. Venclexta (Venetoclax) Product Monograph. https://www.abbvie.ca/content/dam/abbvie-dotcom/ca/en/documents/products/VENCLEXTA_PM_EN.pdf. Accessed January 29, 2022.","alsawaf":"Al-Sawaf O, et al. Venetoclax plus obinutuzumab versus chlorambucil plus obinutuzumab for previously untreated chronic lymphocytic leukaemia (CLL14): follow-up results from a multicentre, open-label, randomised, phase 3 trial.","lancetOncol":"Lancet Oncol","alsawafCont":". 2020;21(9):1188-1200.","cancerCareOnt":" Cancer Care Ontario. FC+R Regimen. August 2020. https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf. Accessed February1, 2022","shadmanM":"Shadman M, et al. Debate: What Is Optimal First-Line Therapy for Chronic Lymphocytic Leukemia?","JNCCN":"JNCCN","shadmanCont":".2020;18(7.5):994-997. doi: 10.6004/jnccn.2020.5011."},"referencesCont":{"sharman":"Sharman JP, et al. Efficacy and safety in a 4-year follow-up of the ELEVATE-TN study comparing acalabrutinib with or without obinutuzumab versus obinutuzumab plus chlorambucil in treatment-naïve chronic lymphocytic leukemia.","leukemia":"Leukemia","sharmanCont":". 2022;36(4):1171-1175.","barrPM":"Barr PM, et al. Up to 8 Years Follow-up From RESONATE-2: First-Line Ibrutinib Treatment for Patients With Chronic Lymphocytic Leukemia.","bloodAdv":"Blood Adv","barrPMCont":". doi:10.1182/bloodadvances.2021006434.","alSawaf":"Al-Sawaf O, et al. Minimal Residual Disease Dynamics after Venetoclax-Obinutuzumab Treatment: Extended Off-Treatment Follow-up From the Randomized CLL14 Study.","jclinoncol":"J Clin Oncol","alSawafCont":". 2021;39(36):4049-4060.","alSawafVen":" Al-Sawaf O, et al. Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 4-year follow-up analysis of the randomized CLL14study. Presented at the European Hematology Association (EHA) Annual Meeting; June 11, 2021.","fisherK":" Fischer K, et al. Long-term remissions after FCR chemoimmunotherapy in previously untreated patients with CLL: updated results of the CLL8 trial. Blood. 2016;127(2):208-221.","zenT":"Zenz T, et al. TP53 mutation and survival in chronic lymphocytic leukemia.","zanTCont":". 2010;28(29):4473-4479.","cancerCareOntAcala":"Cancer Care Ontario. Acalabrutinib –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/63766. Accessed March 15, 2022.","cancerCareOntObinu":"Cancer Care Ontario. Obinutuzumab –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44386. Accessed March 15, 2022.","cancerCareIbru":" Cancer Care Ontario. Ibrutinib –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44366. Accessed March 15, 2022.","cancerCareVen":" Cancer Care Ontario. Venetoclax –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44476.Accessed March 15, 2022.","cancerCareFC":" Cancer Care Ontario. FC Regimen. https://www.cancercareontario.ca/en/system/files_force/FC_HEM_CLL.pdf?download=1. Accessed March 16, 2022.","rochePM":" Roche Canada. Rituxan (Rituximab) Product Monograph. https://www.rochecanada.com/PMs/Rituxan/RituxanIV_PM_E.pdf. Accessed March 16, 2022.","kotiah":"Kotiah SD, et al. Chronic Lymphocytic Leukemia Treatment Protocols.","drugs":"Drugs & Diseases","kotiahLink":" . https://emedicine.medscape.com/article/2005390-overview. Accessed February 8, 2022.","cancerCareIbruReg":"Cancer Care Ontario. IBRU Regimen. https://www.cancercareontario.ca/sites/ccocancercare/files/IBRU_HEM_CLL.pdf . Accessed February 8, 2022."},"referencesCont1":{"fischer":"Fischer K, et al. Venetoclaxand Obinutuzumab in Patients with CLL and Coexisting Conditions.","englj":"N Engl J Med","fischerCont":". 2019;380:2225-2236.","cancerVeneObin":" Cancer Care Ontario. VENE+OBIN Drug Formulary. https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/62876. Accessed February 7, 2022.","cdhta":" Canada’s Drug and Health Technology Agency. https://www.cadth.ca/reimbursement-review-reports. Accessed April 20, 2022.","lymphoma":"Lymphoma Canada. Frontline Therapy Provincial Drug Funding -Chronic Lymphocytic Leukemia (CLL) & Small Lymphocytic Lymphoma (SLL). https://www.lymphoma.ca/wp-content/uploads/2020/12/CLL-SLL-Provincial-Drug-Funding-Table.pdf. Accessed April 20, 2022.","canada":" Government of Canada. https://www.canada.ca/en/indigenous-services-canada/search/advanced-search.html. Accessed April 20, 2022","barrPM":" Barr PM, et al. Acalabrutinib±obinutuzumabversus obinutuzumab+chlorambucilintreatment-naïve chronic lymphocytic leukemia: Elevate-TN four-year follow-up. American Society of Clinical Oncology (ASCO) Annual Meeting; June 4-8, 2021 (ASCO Virtual Meeting). Poster# 7523.","woyach":"Woyach JA, et al. Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL.","woyachCont":". 2018;379(26):2517-2528.","morenoC":"Moreno C, et al. Ibrutinib plus obinutuzumabversus chlorambucil plus obinutuzumabin first-line treatment of chronic lymphocytic leukaemia (iLLUMINATE): a multicentre, randomised, open-label, phase 3 trial.","lancetOncol":"The Lancet Oncology","morecoCont":". 2019;20(1):P43-P56.","shanafelt":"Shanafelt TD, et al. Ibrutinib–Rituximab or Chemoimmunotherapy for Chronic Lymphocytic Leukemia.","shanafeltCont":". 2019;381:432-443."}},"children":["$","body",null,{"className":"bg-whitesmoke __variable_c9fff9","children":[["$","$Le",null,{"lang":"en","dict":{"global":{"site":"This site is intended for Canadian Healthcare Professionals.","submit":"Submit","back":"Back","savePage":"Save Page","logo1":"Communicate & Collaborate","logo2":"in Chronic Lymphocytic Leukemia","click":"Click to reveal","discussionPoint":"If you have any questions or would like to know more about anything you see here, please ask.","filteringNote1":"Note: the ± symbol means “with or without”","filteringNote2":"Note: the + symbol means “with”","treatments":{"acala":"Acalabrutinib","zanu":"Zanubrutinib","ibru":"Ibrutinib","venSolo":"Venetoclax","ven":"Venetoclax + Obinutuzumab","chemo":"Chemo-immunotherapy","acalabrutinib":"Acalabrutinib","zanubrutinib":"Zanubrutinib","ibrutinib":"Ibrutinib","venetoclax":"Venetoclax","venetoclaxIbrutinib":"Venetoclax + ibrutinib","obinutuzumab":"Obinutuzumab"}},"email":{"body":"Here are some of the items we discussed during your visit.","subject":"Resources on your CLL treatment"},"login":{"role":"Role:","physician":"Physician","nurse":"Nurse","pharmacist":"Pharmacist","province":"Province:","license":"License:","licensePlaceholder":"Please enter your medical license number","consent":"As a Canadian healthcare professional, by clicking REGISTER, I Consent to the collection, use and disclosure of my personal information for the purposes identified or described in the","privacyLink":"Privacy Policy","consentCont":", if applicable, or otherwise at the time of collection.","rememberMe":"Remember me","submit":"Sign In"},"index":{},"filtering":{"submit":"Submit","insurance":{"select":"Please select your insurance options"},"province":{"select":"Please select your Province/Territory"}},"nav":{"legal":"Legal Notice","privacy":"Privacy Policy","cookie":"Cookie Policy","report":"Report Adverse Event","contact":"Contact Us","support":"If you need support, please contact Kristin Serodio with Bridge Medical Communications via email","phoneAt":"or phone at","reset":"Reset Tool","cover":"Home","introduction":"Why You Are Here","discuss":"Getting Ready to Start Treatment","treatment-plan-based":"Your Health Factors","options":"Treatment Options","options-tabs":"Treatment Considerations","oss-tabs":"Treatment Outcomes","side-effects":"Side Effects","dosing":"Dosing","schedule":"Treatment Schedules","logistics":"Treatment Logistics","funding":"Funding","summary-questions":"Summary Questions","trial-summaries":"Clinical Trial Summaries","summary":"Patient Resources (Saved Pages)","references":"References","":"External Resources"},"cover":{"title":"Decision Aid","subtitle":"This decision aid was created to help people with CLL like you decide which treatment option suits you and your cancer.","intro":"In this Decision Aid, you will:","learn":"Learn about the benefits and risks of different treatment options","find":"Find out how to manage potential treatment side effects and get help if you need it","discuss":"Discuss and decide with your healthcare team, which treatment option is best for you","caregivers":"Your caregivers are also encouraged to participate in these discussions","start":"Let’s get started","committee":"Scientific Planning Committee","development":"Development of the C³ Decision Aid was directed by a Scientific Planning Committee of a Canadian multi-disciplinary team of healthcare providers, hematologists, a nurse, and pharmacists"},"getStarted":{"title":"What Will Your Treatment Journey Look Like?","subtitle":"We will discuss your treatment journey and considerations along the way","card1":{"title":"Your CLL Treatment Options","goals":"Goals of Initial Conversation","find":"Find out why you are here","discuss":"Discuss your treatment journey and get ready to start treatment","learn":"Learn about how your health factors may affect your treatment","learnMore":"Learn more about your treatment options"},"card2":{"title":"Choosing and Starting Your Treatment","goals":"Goals of Follow-up Conversation","review":"Review what you learned","learn":"Learn more about:","considerations":"Treatment considerations","outcomes":"Treatment outcomes","effects":"Side effects to look out for","dosing":"Dosing","receiving":"Receiving your treatment","discussing":"Discussing treatment coverage"},"card3":{"title":"Continuing Your Treatment","text":"Following your treatment plan gives you the best chance of optimizing your quality of life and keeping your CLL under control"}},"onboarding":{"welcome":"Welcome to the C³ Decision Aid.","intro":"If this is your first time going through this Decision Aid, please follow this quick onboarding tutorial to get to know the interface.","continue":"Continue to onboarding","usedBefore":"I’ve used this Decision Aid before.","start":"Skip onboarding","section1":{"first":{"title":"Progress bar","text":"Keep track of where you are in the Decision Aid. This can be clicked to go back to the Journey page."},"second":{"title":"C³ Logo","text":"Go back home by clicking the logo. This is available on every page."},"third":{"title":"Menu Section","text":"Here you have different toggles to view content depending on your insurance, province or language. You also have access to the menu to jump to various sections of the Decision Aid."}},"section2":{"first":{"title":"Back Button","text":"Click the back button to go to the previous section of the decision aid."},"second":{"title":"Save Page","text":"This button allows you to save this page on the Patient Resources page. Once the page is saved, you can view all of your saved pages at the very end and either print or email the information straight to the patient."},"third":{"title":"Questions Button","text":"Some pages will have this button as a reminder to ask your patient specific questions based on the content of the page. Click here to activate the popup."},"fourth":{"title":"Next Page","text":"Done reviewing this content? Hit next to continue through the decision aid."}},"section3":{"first":{"title":"Stethoscope Icon","text":"Content marked with the stethoscope icon is meant for your (HCP) reference only."}},"finish":"Let's get started"},"introduction":{"title":"Introduction","subtitle":"Why we are here today:","chronic":" Chronic lymphocytic leukemia (CLL) is an ongoing (chronic), slow-growing cancer of the blood","blood":" Blood tests and other symptoms (such as fatigue and swollen lymph nodes) have confirmed progression","monitored":"Your CLL is regularly monitored and may not have needed treatment","discuss":"Let's discuss the next steps together","ref":"CLL = chronic lymphocytic leukemia"},"discuss":{"subtitle":"Discuss your treatment journey and get ready to start treatment:","CLL":"CLL cannot be cured but it can be treated","treatment":" For many patients, CLL treatment can keep the disease under control for extended periods","lets":"So, let’s discuss what a CLL treatment plan is based on…","ref":"CLL = chronic lymphocytic leukemia."},"treatmentPlanBased":{"click":"Click to reveal","subheading":"Your CLL treatment plan is based on:","age":"Your age and fitness","ageText":" Certain treatment options might be preferred depending on your age and your fitness level.","health":"Your overall health:","options":" Certain treatment options might be preferred depending on other conditions you might have (for example, a condition affecting your heart or blood vessels).","type":" The type of CLL you have and some specific characteristics of your disease","genetics":" Cytogenetic testing can help determine your best treatment option. This could be done with a blood or a bone marrow sample","fish":" FISH testing shows whether your cancer cells have certain mutations (changes) in their genetic material (DNA). For this test, a blood sample is collected","optionsMore":"Treatment options:","because":"Because of these factors, ","certain":"certain","optionss":" treatment options may be better able to:","keep":"keep your CLL under control","reduce":"reduce your symptoms","ref":" CLL = chronic lymphocytic leukemia; FISH = fluorescent in situ hybridization; DNA = deoxyribonucleic acid. "},"ways":{"1":"1. A fixed duration (1 - 2 years), or","2":"2. An indefinite duration (as long as the medication is still effective for you), or","3":"3. Until your healthcare team tells you otherwise.","title":"Ways to Receive Your CLL Treatment","subtitle":"Let’s look at how you will receive your treatment","pills":"Pills (by mouth, at home)","atHome":"You will take your medication at home","mustTake":"You must take your medication ","exactly":"exactly","asTold":" as your pharmacist or doctor tells you","byMouth":" You will need to take your medication by mouth on an empty stomach or with food and at the correct dose","for":"You may need to take your medication for:","intra":"Intravenous (IV)","clinic":"You will go to a hospital or outpatient clinic","nurse":" A nurse will put an IV (a soft, flexible tube) into a vein in your chest or in your arm","tube":"You will be given your medication through the tube","hours":"It may take minutes to hours to receive your entire dose","return":" You will need to return several times over a few months","pharma":"As your medication may react with food, remember to talk to your pharmacist about when to take it","ref":"IV = intravenous."},"options":{"title":"Your Treatment Options","heading":"Let’s discuss which treatment options are available to you based on your health, your disease, and your genetic testing results:","subheading":"Genetic Testing Results","testing":"If your testing shows that your cancer cells have any of the following, a targeted therapy might be a good choice for you:","listItem1":"An unmutated IGHV gene (the gene is not changed compared to other cells in your body)","listItem2":"One of the following mutations (changes in your DNA):","del":"del(17p)","or":"or","tp":"TP53","footnote1":"CLL = chronic lymphocytic leukemia; del(17p) = 17p deletion; IGHV = immunoglobulin heavy chain gene; IV = intravenous;","nowrap1":" TP53 = tumour protein p53.","footnote2":"1. Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. 2. Stefaniuk P, et al.","italic1":"Cancer Management and Research.","footnote3":" 2021:13;1459-1476. Walewska R, et al.","italic2":"Br J Haematol.","footnote4":"2022;197(5):544-557."},"optionsBest":{"title":"Your Treatment Options","heading":"Let’s discuss which treatment options are available to you based on your health, your disease, and your genetic testing results:","optionsAre":"Your options for treatment are:","targeted":"Targeted therapies including:","other":"Other non-targeted options include:","chemo":"Chemo-immunotherapy","fcr":"FCR (fludarabine / cyclophosphamide / rituximab)","types":"Types of treatments","capsules":"Capsules","tablets":"Tablets","iv":"IV = intravenous;","injection":"Injection","approved":" †Acalabrutinib is also approved for use with obinutuzumab (Gazyva®), though this combination is only publicly funded in Quebec.","leukemia":"CLL = chronic lymphocytic leukemia;","del":"del(17p) = 17p deletion;","ighv":"IGHV = immunoglobulin heavy chain gene;","tp":"TP53 = tumour protein p53.","footnote1":"1. Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. 2. Stefaniuk P, et al.","italic":"Cancer Management and Research.","footnote2":" 2021:13;1459-1476","modal":{"title":"2022 CARE™ CLL Treatment Guidance"}},"optionsReview":{"title":"Review of Treatment Options","heading":"Let's review what we have learned:","progression":"Disease progression","stage":"At what stage is your cancer?","steps":"What are the next steps in your treatment journey?","types":"Types of treatments","ivOnly":"IV only","ivTablets":"IV and tablets/capsules","tabletsOnly":"Tablets/capsules only","availableOptions":"Your available treatment options","targeted":"Targeted therapies","or":"Or","chemo":"chemo-immunotherapy","fcr":"FCR (fludarabine / cyclophosphamide / rituximab)","point":"If you have any questions or would like to know more about anything you see here, please ask.","approved":"†Acalabrutinib is also approved for use with obinutuzumab (Gazyva®), though this combination is only publicly funded in Quebec.","footnote1":"FCR = fludarabine/cyclophosphamide/rituximab; IV = intravenous. 1. Hallek M, et al.","italic1":"Blood","footnote2":". 2018;131(25):2745-2760. 2. Acalabrutinib PM. 3. Ibrutinib PM. 4. Venetoclax PM. 5. Obinutuzumab PM. 6. Zanubrutinib PM. 7. Owen C, et al. ","italic2":"Curr Oncol","footnote3":". 2018 Oct;25(5):e461-e474."},"treatmentConsiderations":{"title":"Treatment Considerations","heading":"Today, you will find out about:","consider":"Things to consider for each treatment option, including","benefits":"Benefits and risks of each treatment","outcomes":"Outcomes of each treatment option","manage":"How to manage side effects","team":"How your healthcare team will follow up with you and will monitor you on your treatment journey","receive":"How and when you will receive your treatment","ways":"Extra ways to receive care and support on your treatment journey","point":"If you have any questions about what you learn today, you can write them down and bring them to your next appointment."},"optionsTabs":{"title":"Things to Consider for Your Treatment Options","learnAbout":"Let’s learn about the benefits and risks of ","learnAbout2":"Let’s learn about the benefits and risks of ","acala":{"ref1":"CLL = chronic lymphocytic leukemia; TLS = tumour lysis syndrome; 1. Acalabrutinib PM. 2. Byrd JC, et al. ","ital1":"J Clin Oncol","ref2":". 2021;39(31):3441-3452. 3. Owen C, et al. ","ital2":"Curr Oncol","ref3":". 2018 Oct;25(5):e461-e474."},"zanu":{"ref1":"CLL = chronic lymphocytic leukemia. 1. Tam CS, et al. ","ital1":"Lancet Oncol.","ref2":"2022;23:1031-1043."},"ibrutinib":{"ref1":"CLL = chronic lymphocytic leukemia; TLS = tumour lysis syndrome; 1. Ibrutinib PM. 2. Owen C, et al. ","ital1":"Curr Oncol.","ref2":" 2018 Oct;25(5):e461-e474. 3. Byrd JC, et al.","ital2":"J Clin Oncol.","ref3":" 2021;39(31):3441-3452."},"obinutuzumab":{"ref1":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al.","ital2":"J Clin Oncol.","ref3":" 2008;26(16):2767-2778."},"venetoclaxObinutuzumab":{"ref1":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al. ","ital2":"J Clin Oncol. ","ref3":"2008;26(16):2767-2778."},"venetoclax":{"ref1":"CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al. ","ital2":"J Clin Oncol. ","ref3":"2008;26(16):2767-2778."},"chemo":{"ref1":"CLL = chronic lymphocytic leukemia; FCR = fludarabine/cyclophosphamide/rituximab; IV = intravenous. 1. FCR_HEM_CLL.pdf. CCO Formulary August 2020. 2. Owen C, et al.","ital1":"Curr Oncol.","ref2":"2018;Oct;25(5):e461-e474. 3. Shadman M, et al. ","ital2":"JNCCN.","ref3":"2020;18(7.5):994-997. doi:10.6004/jnccn.2020.5011."},"venetoclaxIbrutinib":{"ref1":"CLL = chronic lymphocytic leukemia. 1. Kater AP, et al. ","ital1":"NEJIM Evid.","ref2":"2022;1:7. 2. Coiffer B, et al. ","ital2":"J Clin Oncol.","ref3":" 2008;26(16):2767-2778."}},"ossTabs":{"title":"Treatment Outcomes","learnAbout":"Let’s learn about the outcomes for each treatment","fourYears":"Four years","following":"after starting treatment, clinical trial researchers saw the following rates:","orr":"Overall response rate (ORR)","os":"Overall survival (OS)","pfs":"Progression-free survival (PFS)","more":"More data","definitions":{"def":"DEFINITION ","pfs1":"For patients who respond to treatment, this is the length of time before the cancer gets worse.","pfs2":"In a clinical trial, measuring PFS is a way to see how well a new treatment works.","pfsRef1":"1. National Cancer Institute. Available at:","pfsRefLink":"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/progression-free-survival.","pfsRef2":"Accessed March 15, 2022","orr1":" The percentage of people on a treatment who have a partial or complete response to the treatment within a certain period. A partial response means their tumour or tumours get smaller or in the amount of cancer in the body goes down. A complete response means that all signs of cancer in the body disappear.","orr2":" In a clinical trial, measuring the overall response rate is one way to see how well a new treatment works.","os1":" The length of time from either the date of cancer diagnosis or the start of cancer treatment that patients diagnosed with the disease are still alive.","os2":" In a clinical trial, measuring OS is a way to see how well a new treatment works.","osRef1":"1. National Cancer Institute. Available at:","osRefLink":"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/overall-survival.","osRef2":"Accessed March 15, 2022"},"zanu":{"twoYears":"Two years"},"ibru":{"six":"Six to seven years"},"ven":{"three":"Three to four years","noDifference":"No significant difference in OS","mayEndure":"Treatment response may endure","over":"Over 92%","patients":" of patients who were treated with ","didnot":"did not require","nextLine":" next-line therapy for ","threeOrMore":"3 or more years","after":" after treatment. Next-line therapy is given when a patient’s current treatment stops working"},"chemo":{"five":"Five years","following":"after starting treatment, clinical trial researchers saw the following rates in two types of chemo-immunotherapy (FCR and FC):","mutations":"If your CLL has no mutations in the IGHV gene or has del(17p) or TP53 mutations, chemo-immunotherapy may not be the best treatment option for you."},"venibru":{"learnAbout":"Let’s learn about the benefits and risks of ","three":"Three to four years","ref":" 1. Niemann CU, et al. Residual disease kinetics among patients with high risk factors treated with first line fixed duration ibrutinib plus venetoclax (Ibr+Ven) versus chlorambucil plus Obinutuzumab (Clb+O): the GLOW study. Presented at the American Society of Hematology Annual Meeting; December 10, 2022."},"refs":{"acala1":"*The rate for patients taking acalabrutinib+obinutuzumab was","acala2":"ORR = overall response rate; OS = overall survival; PFS = progression-free survival. 1. Sharman JP, et al. ","ital1":"Leukemia. ","acala3":"2022;36:1171-1175.","zanu1":"*The rate for patients with del(17p) was ","orr":"ORR = overall response rate;","os":"OS = overall survival;","pfs":"PFS = progression-free survival;","zan2":"1. Tam CS, et al. ","zanItal1":"Lancet Oncol.","zanu3":"2022;23:1031-1043.","ibru1":" *These benefits were similar in patients with high-risk CLL (TP53 mutation; unmutated IGHV disease but excluding del(17p)). CLL = chronic lymphocytic leukemia; del(17p) = deletion (17p); IGHV = immunoglobulin heavy chain gene; OS = overall survival; PFS = progression-free survival; TP53 = TP53 protein. 1. Barr PM, et al. ","ibruItal1":"Blood Adv.","ibru2":"doi:10.1182/bloodadvances.2021006434.","ven":" *CLL14 12-month fixed-duration VEN-OBI: 3+ YEAR FOLLOW-UP – OS and PFS were estimated to 4 years. CLL = chronic lymphocytic leukemia; OBI = obinutuzumab; OS = overall survival; PFS = progression-free survival. 1. Al-Sawaf O, et al. ","venItal1":"The Lancet Oncol.","ven2":"2020;21(9):P1188-P1200. doi:10.1016/S1470-2045(20)3043-5. 2. Al-Sawaf O, et al.","venItal2":"J Clin Oncol.","ven3":" 2021;39(36):4049-4060. doi:10.1200/JCO.21.01181. 3. Al-Sawaf O, et al. Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 4-year follow-up analysis of the randomized CLL14 study. Presented at the European Hematology Association Annual Meeting; June 11, 2021. ","chemo":" *CLL8 5.9-year Follow-up. †The OS rate of patients with mutations in the IGHV gene was 86% with FCR and 80% with FC after 5 years. CLL = chronic lymphocytic leukemia; del(17p) = deletion(17p); FC = fludarabine-cyclophosphamide; FCR = fludarabine-cyclophosphamide-rituximab; OS = overall survival; PFS = progression-free survival; TP53 = TP53 protein. 1. Fischer K, et al. ","chemoItal1":"Blood.","chemo2":" 2016;127(2):208-215. 2. Zenz T, et al. J Clin Oncol. 2010;28(29):4473-4479.","venibru":" 1. Niemann CU, et al. Residual disease kinetics among patients with high risk factors treated with first line fixed duration ibrutinib plus venetoclax (Ibr+Ven) versus chlorambucil plus Obinutuzumab (Clb+O): the GLOW study. Presented at the American Society of Hematology Annual Meeting; December 10, 2022. "}},"sideEffects":{"title":"Side Effects","what":"What is a side effect?","a":"A","treatment":"treatment side effect","is":"is a","symptom":"symptom","happens":"that happens due to a drug. Side effects may occur at any dose","know":" We know that these side effects can happen because of familiarity with these drugs","most":"Most","sideEffects":"treatment side effects","may":"may lessen after some time as your body becomes used to the medication","needed":" If needed, lowering the amount of medication you take or stopping the medication may reduce or stop the treatment side effect","discuss":"Always discuss discontinuing or lowering your dose with your doctor","first":"first","before":"before making any changes","lets":"Let’s discuss","so":", so you know:","expect":"What to expect during your treatment","how":"How to manage the side effects when/if they happen"},"sideEffectsTabs":{"title":"Side Effects","whatYouCanDo":" Here’s what you can do at home to try to prevent or manage certain side effects: ","tips":"Tips for Managing Your Side Effects","tipsAtHome":"Managing Side Effects at Home","monograph":"Product Monograph","very":"Very common","veryPeople":"50 or more out of 100 people","common":"Common","commonPeople":"25 to 49 out of 100 people","less":"Less Common","lessPeople":"10 to 24 out of 100 people","talk":"Talk to your doctor if you have any of these symptoms:","acala":{"tips":"","very":"Very common","captionVery":"50 or more out of 100 people","infections":"Infections*","common":"Common","people":"25 to 49 out of 100 people","bleeding":"Bleeding or bruising (common); low platelets in the blood (less common)","headache":"Headache","muscle":"Mild joint or muscle pain or cramps","diarrhea":"Diarrhea","less":"","lessPeople":"","lessList":{"nausea":"Nausea and throwing up (usually mild)","liver":" Liver problems","rash":"Rash and dry, itchy skin","tiredness":"Tiredness","low":"Low white blood cell counts","dizziness":"Dizziness","constipation":"Constipation","high":"High blood pressure","atrial":"Atrial fibrillation","cancer":"Cancer cells dying quickly when you start treatment (in severe cases TLS can happen, which may impact how well your organs work)"}},"tipsForHome":{"refs1":{"acala":"1. Acalabrutinib PM.","zanu":"1. Zanubrutinib PM.","ibru":"1. Ibrutinib PM.","ven":"1. Venetoclax PM.","chemo":"1. Rituximab PM. 2. Fludarabine PM."},"acala":{"toHelp":"To help prevent","infections":"infections","precautions":"Take certain precautions (eg, handwashing, mask wearing)","makeSure":"Make sure you and your close contacts are up - to - date on vaccinations","helpManage":"To help manage","headaches":"headaches","takeCaffeine":"Take caffeine (eg, coffee); if your headache doesn't go away, talk to your healthcare provider about medications you can take to manage your headache. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","aid":"To help manage","diarrhea":"diarrhea","increase":"Increase your intake of clear fluids (non-caffeinated, non-alcoholic, non-carbonated)","eatSmaller":"Eat smaller and more frequent meals consisting of low-fibre, high-calorie foods, like the BRAT (bananas, rice, applesauce, toast) diet ","avoid":"Avoid foods high in fat, sugar, and lactose, as well as acidic, spicy, or gas-producing foods","ask":"Ask your doctor about taking medications to help with diarrhea","helpManageAndPrevent":"To help manage and prevent","joint":"joint or muscle pain","talk":"Talk to your healthcare provider about medications you can take to manage your pain. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","stretching":"Do stretching and strengthening routines","apply":"Apply hot and/or cold compresses as needed","water":"Drink a lot of water","drinkTonic":"Drink tonic water in the evening to reduce muscle cramping at night","change":"Change your plans to lighten your load","ref1":"1. Banerji V, et al. Curr Oncol. 2020;27(6):e645-e655.","ref2":"2. Government of Canada. Immunization of immunocompromised persons: Canadian Immunization Guide. Dec 24, 2020. ","ref3":"3. Herishanu Y, Perry C. Blood. 2021;138(18):1652-1653.","ref4":"4. Diarrhea. Canadian Cancer Society website. ","link":"https://cancer.ca/fr/treatments/side-effects/diarrhea.","assessed":"Accessed April 29, 2022.","ref5":"5. Nierman P. Clin J Oncol Nurs. 2021;25(6):687-696.","ref6":"6. Cleveland Clinic website. Musculoskeletal Pain.","ref6Link":"https://my.clevelandclinic.org/health/diseases/14526-musculoskeletal-pain.","asessed6":"Accessed April 29, 2022. ","ref7":"7. Badillo M, et al. Clin J Oncol Nurs. 2022;24:392-398."},"zanu":{"toHelp":"To help prevent","infections":"infections","precautions":"Take certain precautions (eg, handwashing, mask wearing)","makeSure":"Make sure you and your close contacts are up - to - date on vaccinations","helpManage":"To help manage","headaches":"headaches","takeCaffeine":"Take caffeine (eg, coffee); if your headache doesn't go away, talk to your healthcare provider about medications you can take to manage your headache. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","aid":"To help manage","diarrhea":"diarrhea","increase":"Increase your intake of clear fluids (non-caffeinated, non-alcoholic, non-carbonated)","eatSmaller":"Eat smaller and more frequent meals consisting of low-fibre, high-calorie foods, like the BRAT (bananas, rice, applesauce, toast) diet ","avoid":"Avoid foods high in fat, sugar, and lactose, as well as acidic, spicy, or gas-producing foods","ask":"Ask your doctor about taking medications to help with diarrhea","helpManageAndPrevent":"To help manage and prevent","joint":"joint or muscle pain","talk":"Talk to your healthcare provider about medications you can take to manage your pain. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","stretching":"Do stretching and strengthening routines","apply":"Apply hot and/or cold compresses as needed","water":"Drink a lot of water","drinkTonic":"Drink tonic water in the evening to reduce muscle cramping at night","change":"Change your plans to lighten your load"}},"zanu":{"lowSugar":"Low blood sugar*","lowBlood":"Low blood cell counts*","muscle":"Muscle or joint pain*","upper":"Upper respiratory tract infection*","bleeding":"Bleeding*","rash":"Rash*","bruising":"Bruising","abnormalKidney":"Abnormal kidney lab tests*","abnormalLiver":"Abnormal liver lab tests*","cough":"Cough","highBlood":"High blood pressure*","diarrhea":"Diarrhea*","pneumonia":"Pneumonia*","tiredness":"Tiredness*","another":"Another type of cancer*","headache":"Headache","dizziness":"Dizziness*","constipation":"Constipation*","nausea":"Nausea","atrial":"Atrial fibrillation†"},"ibru":{"higher":"Higher than normal white blood cell counts","diarrhea":"Diarrhea","headache":"Headache","muscle":"Mild joint or muscle pain or cramps","tiredness":"Tiredness","high":"High blood pressure","low":"Low appetite (not wanting to eat)","cough":"Cough and feeling short of breath","nausea":"Nausea and throwing up","rash":"Rash and dry, itchy skin","swelling":"Mild swelling","eye":"Eye problems*","constipation":"Constipation","infections":"Infections (incl. pneumonia, skin infections)","lowWhite":"Low white blood cell counts*","atrial":"Atrial fibrillation"},"ven":{"low":"Low white blood cell counts*","platelets":"Low platelets in the blood*","allergic":"Allergic reaction*","diarrhea":"Diarrhea","nausea":"Nausea and throwing up (usually mild)","tiredness":"Tiredness","headache":"Headache","mild":"Mild joint or muscle pain or cramps","fever":"Fever, chills, infection*","liver":"Abnormal liver lab tests*","kidney":"Abnormal kidney lab tests*","bleeding":"Bleeding*","cough":"Cough and feeling short of breath","swelling":"Mild swelling","cramps":"Pain or cramps in the belly","rash":"Rash and dry, itchy skin","salt":"Too much or too little salt in your body","constipation":"Constipation","dizinness":"Dizziness","mouth":"Mouth sores","tls":"TLS (cancer cells dying quickly when you start treatment, which might impact how well your organs work)"},"chemo":{"one":"Myelosuppression (when fewer blood cells are made) with or without bleeding","infection":"Infection","nausea":"Nausea/throwing up, diarrhea, refusing to eat","fever":"Fever","liver":"Abnormal liver lab tests","tiredness":"Tiredness","rash":"Rash*","vision":"Changes in vision","bladder":"Inflamed bladder","fertility":"Risk to fertility and the ability to have children","autoimmune":"Autoimmune disorders","brain":"Encephalopathy (a brain disorder), seizures, feeling confused or agitated","lungs":"Inflamed lungs","heartFailure":"Heart failure, irregular heartbeat","clots":"Blood clots","siadh":"SIADH (a disorder that causes too little salt in the body)","dic":"DIC (a disorder of the proteins that help blood to clot)","cancer":"Developing a secondary cancer","vod":"VOD, HUS (disorders affecting blood flow to the liver and kidneys)","tls1":"Tumour lysis syndrome (TLS; TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work)","kidney":"Kidney failure","pancreas":"Inflamed pancreas","rhab":"Rhabdomyolysis (a syndrome where muscles break down)","graft":"Transfusion-associated graft-versus-host disease (when transfused blood components attack the patient’s body due to chemotherapy’s immune effects)","bleeding":"Bleeding issues","heartIssues":"Heart issues (including irregular heartbeat, chest pain)","weakness":"Weakness, memory problems, changes in vision, mood changes, loss of speech, numbness","hepat":"Hepatitis B infection","shingles":"Shingles","infusion":"Infusion-related reactions (fever and chills, nausea, throwing up, skin rash, swelling, difficulty breathing)","redness":"Redness, blisters on skin and/or mouth","kidneyProblems":"Kidney problems (may see swelling, side/back pain)","tls":"TLS"},"refs":{"maybe":"*May be severe","less":"†Less common than 10%","tls":"TLS = tumour lysis syndrome; PM = product monograph","cancerCare":"1. Cancer Care Ontario. Acalabrutinib – Patient Info Sheet. Available at:","cancerCareLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/63766.","assessed":"Accessed March 15, 2022. 2. Coiffer B, et al. ","oncol":"J Clin Oncol.","oncol2":" 2008;26(16):2767-2778.","acala":"3. Acalabrutinib PM. 4. Byrd JC, et al. ","lancet":"Lancet Oncol.","acala2":"2021;39(31):3441-3452.","zanu":"1. BRUKINSA PM. 2. Tam CS, et al. ","zanu2":"2022;23:1031-1043.","pm":"PM = product monograph.","ibru":"1. Cancer Care Ontario. Ibrutinib –Patient Info Sheet. Available at:","ibruLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44366.","ibruAcessed":"Accessed: March 15, 2022. 2. Ibrutinib PM.","obinu":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","obinu2":" 2020;21(9):1188-1200. 4. Coiffer B, et al.","obinu3":"2008;26(16):2767-2778.","venTLS":"TLS = tumour lysis syndrome","ven1":" 1. Cancer Care Ontario. Venetoclax –Patient Info Sheet. Available at:","venLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44476.","venAssessed":" Accessed: March 15, 2022. 2. Cancer Care Ontario. Obinutuzumab –Patient Info Sheet.","venLin2":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44386.","venAssessed2":"Accessed: March 15,2022. 3. Coiffer B, et al.","ven3":"2008;26(16):2767-2778.","chemo1":" CNS = central nervous system; DIC = disseminated intravascular coagulation; FC = fludarabine/cyclophosphamide; HUS = hemolytic uremic syndrome; SIADH = syndrome of inappropriate antidiuretic hormone; TLS = tumour lysis syndrome; VOD = veno-occlusive disease.","cancerCareFC":"1. Cancer Care Ontario FC Regimen","chemo2":"https://www.cancercareontario.ca/en/system/files_force/FC_HEM_CLL.pdf?download=1.","chemoAssessed":"Accessed: March 15, 2022. 2. Rituximab Product Monograph 3. Coiffer B, et al.","chemo3":"2008;26(16):2767-2778.","venibru":" CLL = chronic lymphocytic leukemia. 1. Kater AP, et al.","evid":"NEJIM Evid.","venibru2":"2022;1:7. 2.","veinbru3":" Coiffer B, et al.","veinbru4":"2008;26(16):2767-2778.","obinuModal":{"ref1":"1. Cancer Care Ontario. Obinutuzumab –Patient Info Sheet. Available at:.","ref1Asessed":"Accessed : March 15, 2022."},"venibruModal":{"pms":"1. VENCLEXTA PM. 2. IMBRUVICA PM. 3. KaterAP, et al."}}},"dosing":{"title":"Dosing","keep":"As you receive your treatment, here are some things your healthcare providers and you need to keep in mind:","acala":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":"Take your acalabrutinib tablets exactly as your healthcare professional tells you. If you are on 2 tablets a day, take them about 12 hours apart","same":"Take about the same time each day","with":"Take with or without food","swallo":" Swallow them whole with a glass of water. Do not chew, crush, dissolve, or divide the tablets","bold1":"Do not","takeCertain":" take certain medications called strong or moderate CYP3A4 and/or CYP3A4 inducers. A few examples are:","inhibitors":"Inhibitors: Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","inducers":" Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","discuss":" Discuss with your doctor the benefits and risks of stopping acalabrutinib for at least 3 days before and after having surgery","talk":"Talk to your healthcare provider if you have","bleeding":"bleeding problems, or before you plan on taking medicines that may increase your risk of bleeding,","including":"including:","aspirin":"aspirin and anti-inflammatories such as ibuprofen or naproxen","thinners":"blood thinners such as warfarin, heparin or other medicines to treat or prevent blood clots such as dabigatran, rivaroxaban, apixaban","supplements":"supplements such as fish oil, vitamin E and flaxseed"},"zanu":{"take":"Take your zanubrutinib capsules exactly as your healthcare professional tells you.","swallow":"Swallow them whole with a glass of water. Do not open, break, or chew the capsules","bold1":"Do not","takeCertain":"take certain medications called strong or moderate CYP3A4","inducers":"inducers.","examples":"A few examples are:","gloc":"Some glucocorticoids, anti-seizure medications, St. John’s Wort","caution":"Take caution","strong":" with certain medications called strong or moderate CYP3A","inhibitors":"inhibitors","doctor":". Your doctor will give you a lower dose of zanubrutinib. A few examples are:","antifungals":" Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","discuss":"Discuss with your doctor the benefits and risks of stopping zanubrutinib for at least 3 days before and after having surgery","talk":"Talk to your healthcare provider if you have","bleeding":" bleeding problems, or before you plan on taking medicines that may increase your risk of bleeding,","including":" including:","aspirin":"aspirin and anti-inflammatories such as ibuprofen or naproxen","thinners":" blood thinners such as warfarin, heparin or other medicines to treat or prevent blood clots such as dabigatran, rivaroxaban, apixaban","supplements":"supplements such as fish oil, vitamin E and flaxseed"},"ibru":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":" Take your ibrutinib capsules by mouth once per day","swallow":" Swallow them whole with a glass of water","donot":" Do not open, crush, or chew the capsules","takeSame":" Take your ibrutinib capsules at about the same time each day","bold1":"Do not","grape":"take your ibrutinib capsules with grapefruit juice or fish oils","strong":" take certain medications called strong CYP3A4","inhibitors":" inhibitors","and":"and/or CYP3A4","inducers":" inducers","examples":". A few examples are:","inhibitorsEx":" Inhibitors: Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","inducersEx":" Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","if":" If you have moderate or severe liver problems, you should not take ibrutinib","let":"Let your healthcare provider know if","unusual":" you have unusual bleeding or bruising or plan on taking any medicines that may increase your risk of bleeding,","such":" such as:","aspirin":" Aspirin, anti-inflammatories (e.g., ibuprofen, naproxen, and others), warfarin, heparin, other medications to prevent or treat blood clots (e.g., dabigatran, rivaroxaban, apixaban), or any supplements that increase your risk of bleeding such as fish oil, flaxseed, or vitamin E","discuss":"Discuss with your doctor the benefits and risks of stopping ibrutinib at least 3 days before and after surgery"},"ven":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","while":" While receiving venetoclax treatment, you are at risk of developing tumour lysis syndrome (TLS). TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work, and requires hospitalization","when":" When you first start your venetoclax treatment, you need to be monitored closely in hospital with frequent blood work to look for signs of TLS","healthcare":"Your healthcare team will assess your risk of TLS","if":"If you are prescribed allopurinol, it is important to stay hydrated","should":"You should receive obinutuzumab as an","iv":"IV infusion only","shouldReceive":" You should receive 9 infusions in a hospital or other location where equipment is available for life-saving action in the event of an emergency","doctor":"An experienced doctor should care for you or supervise your care","infusion":"Obinutuzumab infusions should","not":"not","beGiven":" be given too quickly (this is called a bolus or push)","kidney":"If you have kidney problems, you may experience more side effects. These side effects could include TLS"},"chemo":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","usually":" Usually, you will receive a total of six (6) chemotherapy cycles unless your cancer gets worse, or the side effects become too difficult for you","if":" If your blood test results show that your white blood cell and platelet counts are too low after one cycle, your next cycle may start one week later than scheduled","if2":" If your blood tests continue to show low white blood cell and platelet counts, or you develop a major infection, your dose of two of your chemotherapy drugs (fludarabine and cyclophosphamide) will be lowered","if3":"If you are at a higher risk for tumour lysis syndrome (TLS), you will take another medication to help prevent TLS.","if4":"TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","treatment":" Your treatment may be different based on your age and on your genetic testing results","not":"Chemo-immunotherapy with FCR is not recommended for patients with ","del":"del(17)p","mutations":"mutations","instead":"Instead, the recommended treatments to start with are:","acala":"Acalabrutinib ± obinutuzumab","ibru":"Ibrutinib","ven":"Venetoclax + obinutuzumab"},"obinu":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","should":"You should receive obinutuzumab as an","iv":"IV infusion only","shouldReceive":" You should receive it in a hospital or other location where equipment is available for life-saving action in the event of an emergency","obinuShould":"Obinutuzumab infusions should","not":"not","beGiven":"be given too quickly (this is called a bolus or push)","kidney":" If you have kidney problems, you may experience more side effects, which could include tumour lysis syndrome (TLS; TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work)"},"venibru":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":"Take your ibrutinib capsules by mouth once per day ","swallow":"Swallow them whole with a glass of water","donot":" Do not open, crush, or chew the capsules","takeSame":"Take your ibrutinib capsules at about the same time each day","bold1":"Do not","grape":"take your ibrutinib capsules with grapefruit juice or fish oils","strong":" take certain medications called strong CYP3A4","inhibitors":" inhibitors","and":"and/or CYP3A4","inducers":" inducers","examples":". A few examples are:","inhibitorsEx":"Inhibitors: Certain antifungals, antibiotics, blood pressure medications, grapefruit juice","inducersEx":"Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","if":" If you have moderate or severe liver problems, you should not take ibrutinib","while":"While receiving venetoclax treatment, you are at risk of developing tumour lysis syndrome (TLS). TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work, and requires hospitalization","when":"When you first start your venetoclax treatment, you need to be monitored closely in hospital with frequent blood work to look for signs of TLS","healthcare":"Your healthcare team will assess your risk of TLS"},"refs":{"acala1":"CYP3A4 = cytochrome P450 3A4; IV = intravenous; PPI = proton pump inhibitors;","acala2nowrap":"TLS = tumour lysis syndrome.","acala3":"1. Acalabrutinib PM.","acala4":"2. Obinutuzumab PM. 3. Coiffer B, et al.","acalaItal":"J Clin Oncol.","acala5":"2008;26(16):2767-2778.","zanu":"CYP3A4 = cytochrome P450 3A4. 1. BRUKINSA PM.","ibru":"CYP3A4 = cytochrome P450 3A4; PM = product monograph. 1. Ibrutinib PM.","ven1":" IV = intravenous; PM = product monograph; TLS = tumour lysis syndrome. 1. Venetoclax PM.","ven2":" 2. Obinutuzumab PM. 3. Coiffer B, et al.","venItal":"J Clin Oncol.","ven3":"2008;26(16):2767-2778.","chemo1":"del(17p) = deletion 17p; FCR = fludarabine/cyclophosphamide/rituximab;","chemo2nowrap":"TLS = tumour lysis syndrome.","chemo3":"1. Cancer Care Ontario. FC+R Regimen. August 2020.","chemo4break":"https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf.","chemo5":"Accessed Feb 8, 2022.","chemo6":" 2. Kotiah SD, et al. Drugs & Diseases. Accessed February 8, 2022.","chemo7break":"https://emedicine.medscape.com/article/2005390-overview.","chemo8":"3. Coiffer B, et al. J Clin Oncol. 2008;26(16):2767-2778."}},"schedule":{"title":"Treatment Schedule","lets":"Let’s compare the schedules for each treatment choice.","calendar":" This calendar shows when you will receive your medication.","calendars":"These calendars show when you will receive your medications.","available":"Available as an outpatient prescription, which means you take it at home","morning":"Morning","everyDay":"every day","evening":"Evening","once":"Once","or":"or","everyDay2":"every day","continueUntillDifficult":"Continue taking it unless your cancer gets worse or the side effects become too difficult for you","another":"Another treatment may be required","nausea":"for nausea or throwing up","if":"If you experience nausea and vomiting, your doctor may prescribe you a medication (an antiemetic) to help manage these symptoms","risk":"If you are at risk for a side effect called tumour lysis syndrome (TLS), your physician will monitor you closely and may decide to give you a treatment to help prevent it","tls":"TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","infections":"If you are at risk for certain infections, your physician may decide to give you a treatment to help prevent them","day12815":"Day 1, 2, 8, 15","atleast4":"(at least 4 hours for infusion)","day22":"Day 22","start":"Start ramp-up","dose":"Dose increases weekly until week 5","day1":"Day 1","everyCycle":"every cycle;first cycle will be lower dose (4 hours for infusion)","everyCycle2":"every cycle","EveryDay":"Every day","takenFor5":"Taken on Day 1 for 5 cycles (6 total)","continue12thCycle":"Continue until the end of the 12th cycle unless your cancer gets worse or the side effects become too difficult for you","continue15thCycle":"Continue until the end of the 15th cycle unless your cancer gets worse or the side effects become too difficult for you","startUntill5":"Start ramp-up dose increases weekly until week 5","cycle1IV":"Cycle 1 given by IV, cycles 2–6 given by a needle (subcutaneously [under the skin])","day12345":"Day 1, 2, 3, (4 & 5)","mostTake":"Most patients take this medication on days 1–3 of each cycle, while some take it on days 1–5","ifReq":"If required","forNausea":"for nausea or throwing up","forTLS":"for TLS and infection prevention","monitor":"Your healthcare team will monitor you closely to help prevent tumour lysis syndrome (TLS).","tlsCanHappen":" TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","note":"Note: This is an example of how you may receive this treatment. A doctor who is trained in the use of chemotherapy will give this treatment. ","mayAdjust":"They may adjust the treatment depending on how your body tolerates the medications.","ref1":"IV = intravenous; PM = product monograph. 1. Acalabrutinib PM. 2. Obinutuzumab PM.","ref1Zanu":"PM = product monograph. 1. BRUKINSA PM.","ref2":"PM = product monograph; TLS = tumour lysis syndrome. 1. Ibrutinib PM. 2. Cancer Care Ontario. IBRU Regimen. ","ref2Link":"https://www.cancercareontario.ca/sites/ccocancercare/files/IBRU_HEM_CLL.pdf.","ref2Assessed":"Accessed: February 8, 2022.","ref3":"3. Coiffer B, et al. ","ref3Ital":"J Clin Oncol.","ref3cont":"2008;26(16):2767-2778.","ref4":"VEN = venetoclax. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Fischer K, et al.","ref4ital":"N Engl J Med.","ref4cont":"2019;380:2225-2236. 4. Cancer Care Ontario. VENE+OBIN Drug Formulary.","ref4Link":"https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/62876.","ref4accessed":"Accessed: Feb 7, 2022.","ref5chemo":"IV = intravenous; PM = product monograph; TLS = tumour lysis syndrome. 1. Cancer Care Ontario. FC+R Regimen. August 2020.","ref5chemoLink":" https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf. ","ref5chemoAssessed":" Accessed Feb 8, 2022. 2 Rituximab PM. 3. Coiffer B, et al. J Clin Oncol. 2008;26(16):2767-2778."},"logistics":{"title":"Logistics for Receiving Your Treatment","gettingToHospital":"Getting to the hospital/infusion centre","IVsupport":"Support for IV infusion visits","multipleVisits":"Multiple healthcare provider visits","waitTimes":" Wait times for infusions and hospital beds","doctorWillMonitor":" Your doctor will need to monitor you (in-person) for some side effects","addmitted":"May need to be admitted to the hospital for TLS due to venetoclax","addmittedChemo":"May need to be admitted to the hospital for TLS due to chemo","eachCycle":"*Each cycle is 28 Days","waitTimes2":"Wait times for infusions / hospital beds","ivTLS":" IV = intravenous; TLS = tumour lysis syndrome."},"funding":{"title":"Funding for Previously Untreated CLL by Province","approval":"Health Canada Approval","recommendation":"Recommendation","NIHB":"NIHB","reimburseCond":"Reimburse with clinical criteria and/or conditions","underReview":"Under reimbursement review","refa":" a For the treatment of patients with previously untreated CLL for whom a fludarabine-based regimen is inappropriate.","refb":"b First-line tx of pts with CLL and a CIRS ≤6.","refc":"c ± Obinutuzumab","refd":"d Limited use benefit (prior approval required).","cirs":" CIRS = cumulative illness rating scale;","cll":" CLL = chronic lymphocytic leukemia;","nihb":" NIHB = Non-Insured Health Benefits Program;","pts":" pts = patients; tx = treatment.","link1":"1. https://www.cadth.ca/reimbursement-review-reports.","link2":"2. https://www.lymphoma.ca/wp-content/uploads/2020/12/CLL-SLL-Provincial-Drug-Funding-Table.pdf.","link3":" 3. https://www.canada.ca/en/indigenous-services-canada/search/advanced-search.html;"},"summaryQuestions":{"title":"Summary Questions to Ask","lets":" Let’s review the following questions to make sure you and your caregiver(s) understand what was discussed","believe":" Do you believe that you have a good understanding of the Treatment Options available to treat your CLL?","areyou":"Are you and your caregiver(s) satisfied that you have enough information to select a treatment option if not today, then at the next visit?","support":"Do you believe that your support team understands how they may help you once you start your treatment journey?","other":"Are there any other questions that you would like to ask me today?","think":"If you think of any questions regarding your treatment journey,","write":"please write them down","discuss":" we will discuss them next time."},"trialSummaries":{"title":"Clinical Trial Summaries","treatment":"Treatment","name":"Trial name","design":"Trial design","population":"Population","outcomes":"Primary outcomes","secondary":"Select secondary outcomes","safety":"Safety","other":"Other safety comments","elevate5follow":"ELEVATE-TN 5-Yr Follow-up","acalobin":"ACAL ±OBIN vs OBIN + Clb","phase3":"Phase 3, multi-centre,","openLabel":"open label","ptsAged":"Pts aged ≥65 years or","crcl":"18-64 years with CrCl< 70 mL and/or CIRS-G score >6","medianPFS":"Median PFS:","nrao":"NR (A + O) vs NR (A) vs 27.8 mos (O + Clb) (","P":"P","<0":"<0.0001)","estPFS60":"Est. PFS at 60 mos:","84%":"84% (A + O) vs 72% (O)","vs21%":"vs 21% (O + Clb)","estimatedOS60":"Estimated OS at 60 mos: ","90%ao":"90% (A + O) vs 84% (A), vs 82% (O + Clb)","odr":"ODR:","35%ao":"35% (A + O), 40% (A), and 23% (O + Clb)","mostCommonReasons":"Most common reasons:","AEs":"AEs: (17% [A + O], 16% [A], 14% [O + Clb])","pdao":"PD: (6% [A + O], 10%[A], 2% [O + Clb])","safetyAO":"Safety of A + O and A mono-therapy maintained","ibru":"I = ibrutinib;","resonate2":"RESONATE 2","8yrFollowUp":"8-Yr Follow-up","ibrVSclb":"IBR vs Clb","phase3RCT":"Phase 3, RCT, double-blind, multi-centre, open label","ptsAged65":"Pts aged ≥65 years","without":"without","del(17p)":"del(17p)","neVS15":"NE vs 15.0 mos (HR 0.16; 95% CI .11-0.23)","estPFSat7yrs":"Est. PFS at 7 years:","59%I":"59% (I) vs 9% (Clb)","estOSibr":"Est. OS for IBR at 7 years:","78%":"78%","grade>3":"Grade ≥3 infectious complications:","hyper12%":"Hypertension: 12% Afib: 6%","grade>3hemor":"Grade ≥3 major hemorrhage: 7%","8yrFollow":"8-year follow-up:","noSafetySignals":"no new safety signals","alliance":"ALLIANCE A041202","ibr+rtx":"IBR + RTX vs. BEN + RTX","phase3RCTsolo":"Phase 3, RCT","reachedOnlyBen":"reached only with BEN + RTX","est24mPFS":"Est. 24-mos PFS:","74%brI":"74% (BR) vs 87% (I) vs 88% (I+R)","os":"OS:","noSigDifference":"No significant difference among the three treatment groups","grade3hema":"Grade ≥3 hematologic AEs:","61BRI":"61% (BR) vs 14% (I)","vs39":"vs 39% (I+R)","grade3nonhema":"Grade ≥3 nonhematologic AEs","63%BRIbru":": 63% (BR) vs 74% (I/I+R)","n/a":"N/A","iLL":"iLLUMINATE","ibrObi":"IBR + OBI vs Clb+ OBI","phase3RCTmulti":"Phase 3, RCT, multi-centre, open label","ptsAged65orComor":"Pts aged ≥65 years or < 65 years with comorbidities*","cirs6":"*CIRS > 6, CrCl< 70 mL/min, and/or","deltp53":"del(17p)/TP53","mut":"mut","nr":" NR vs 19.0 mos (HR 0.23; 95% CI 0.15-0.37;","<0.01":"<0.001)","est30m":"Est. 30-mos PFS:","79%vs31%":"79% vs 31%","pfsInHighRisk":"PFS in high-risk patients: ","nrVS14":"NR vs 14.7 mos (HR 0.15; 95% CI 0.09-0.27; ","osRate30":"OS rate at 30 mos:","86vs85":"86%vs 85%","mostCommonGrade":"Most common grade 3/4 AEs:","neutrop":"Neutropenia & thrombocytopenia","saes58":"SAEs: 58% vs 35%","trd":"Treatment-related deaths: ","1bothArms":"1% in both arms","ecog":"ECOG-ACRIN E1912","ibr":"IBR + RTX vs FCR","phase3RCTopen":"Phase 3, RCT, multi-centre, open label","ptsAged70":"Pts aged ≤ 70 years","stratified":"Stratified according to age, ECOG-PS, Rai stage and","del11q23":"del11q23","presenceabsence":"presence/absence","exclusions":"Exclusions: Pts with","del(17)p":"del(17p)","pfsAt3yrs":"PFS at 3-yrs:","89vs73":" 89% vs 73% ","hr035":"(HR 0.35; 95% CI 0.22-0.56;","os3ys":"OS at 3-yrs:","99vs92":"99% vs. 92%","hr017":"(HR 0.17; 95% CI 0.05-0.54;","grade3AEs":"Grade ≥3 AEs:","80%bothArms":"80% in both arms","11vs20":"11% vs 20% (","ven":"Venetoclax","plusobinu":"(+ obinutuzumab)","cll14":"CLL14","5ysFollowUp":"5-Yr Follow-up","vene":"VENE + OBIN vs Clb+ OBIN","phase3MultiCenter":"Phase 3, multi-centre,","openlabel":"open label","ptsWithUntreated":"Pts with previously untreated CLL and coexisting medical conditions (CIRS > 6 and/or CrCl< 70 mL/min)","estPFS5ys":"Est. PFS at 5 years:","62vs27":" 62.6% vs 27.0% (HR0.35; 95% CI 0.26-0.46,","<0.0":"<0.0001)","estOS5ys":"Est. OS at 5 years:","88vs77":"88.9% vs 77.0% (HR 0.72; 0.48-1.09,","=0.12":"=0.12)","mostFrGrade":"Most frequent grade 3/4 AE:","neutropeniaVEN":"Neutropenia (52% [VENE + OBIN] vs 47% [Clb+ OBIN])","patientsWithAtLeast1":"Number of patients with at least 1 SPM:","21VenVS15":"21% (VENE + OBIN) vs 15% (Clb+ OBIN) = NS","all-case":"All-cause mortality:","9%vene":"9% (VENE+ OBIN) vs. 8%","clbObin":"(Clb+ OBIN) = NS","acala":"A = acalabrutinib;","acalal":"ACAL = acalabrutinib;","ben":"BEN = bendamustine;","br":"BR = bendamustine + rituximab;","celsius":"C = celsius;","ci":"CI = confidence interval;","cirs-g":"CIRS-G = Cumulative Illness Rating Scale –Geriatric;","clb":"Clb = chlorambucil;","cll":"CLL = chronic lymphocytic leukemia;","CrCL":"CrCl = creatinine clearance;","delpdef":"del(17p) = deletion 17p;","cgdef":"COG = Eastern Cooperative Oncology Group scale;","estdef":"est = estimated;","F":"F = fahrenheit;","HR":"HR = hazard ratio;","word":"IBR = ibrutinib;","mosdef":"mos = months;","NEdef":"NE = not estimated;","nrdef":"NR = not reached;","obinu":"O = obinutuzumab;","obinubi":"OBI = obinutuzumab;","osdef":"OS = overall survival;","pfsdef":"PFS = progression-free survival;","ptsdef":"Pts = patients;","rtxdef":"RTX = rituximab;","spmdef":"SPM = second primary malignancy;","venedef":"VENE = venetoclax;","ydef":"y = year;","yrdef":"Yr = year. 1. Sharman JP, et al. American Society of Clinical Oncology (ASCO) Annual","ref1":"Meeting; June 2-6, 2021. Poster #7539. 2. Barr PM, et al. American Society of","ref2":"Clinical Oncology (ASCO) Annual Meeting; June 4-8, 2021 (ASCO Virtual Meeting).","ref3":"Poster# 7523. 3. Woyach JA, et al.","engl":"N Engl J Med","ref4":". 2018;379(26):2517-2528. 4. Moreno C, et al.","oncol":"The Lancet Oncol","ref5":". 2019;20(1):P43-P56. 5. Shanafelt TD, et al.","ref6":". 2019;381:432-443. 6. Fischer K, et al.","ref7":". 2019;380:2225-2236."},"trialSummariesCont":{"glow4yr":"GLOW 4-Yr Follow-up","estPFS42":"Est. PFS at 42 mos:","ptsAged65":"Pts aged ≥65 years or 18-64 years with CrCl< 70 mL or CIRS >6","ptsAged65Comor":"Pts aged ≥65 years or 18-64 years with comorbidities and CrCl< 70 mL or CIRS >6","nrvi":"NR (V + I) vs 21.0 mos (O + Clb) (","nrz":"NR (Z) vs 28.1 mos (B + R) (","p":"P","75vi":"75% (V + I) vs 25% (O + Clb)","<001":"<0.001)","<0001":"<0.0001)","estPFS24":"Est. PFS at 24 mos:","85zbr":"85.5% (Z) vs 69.5% (B + R)","estOS42":"Estimated OS at 42 mos:","osVI88":"88% (V + I) vs 78% (O + Clb)","estOS24":"Estimated OS at 24 mos:","94zvs94br":"94.3 (Z) vs 94.6% (B+R)","grad34ae":"Grade 3/4 AEs:","neutropenia11z":"Neutropenia (11% [Z] vs 51% [B + R])","hypertension":"Hypertension (6% [Z] vs 5% [B + R])","cardiac":"All cardiac AEs (4% [Z]","vs4":"vs 4% [B + R])","aeDeath":"AE leading to death:","neutropenia34":"Neutropenia (34.9% [V + I] vs 49.5% [O + Clb])","infections15":"Infections (15.1% [V + I] vs 10.5% [O + Clb])","hyper75":"Hypertension (7.5% [V + I] vs 1.9% [O + Clb])","atrial6":"Atrial fibrillation (6.6% [V + I] vs 0% [O + Clb])","11inZ":"11 in Z arm and 12 in B + R arm","relatedDeaths":"Treatment-related deaths:","moreDeaths":"more deaths during","randomizedTreatment":"randomized treatment in","viArms":"V + I arm vs O + Clb arm","note":"Note: Cross-comparisons between treatment studies should not be inferred.","ae":" AE, adverse event;","bben":" B/BEN, bendamustine;","clb":" Clb, chlorambucil;","cirs":" CIRS, Cumulative Illness","rating":" Rating scale CrCl = creatinine clearance; ","iibr":" I/IBR, ibrutinib; ","mo":" mo = month; ","nr":" NR, not reached; ","oobin":" O/OBIN = obinutuzumab; ","os":" OS, overall survival; ","pfs":" PFS, progression-free survival;","pt":" Pt, patient; ","rrtx":" R/RTX, rituximab; ","vven":" V/VEN = venetoclax; ","yr":" Yr = year; ","zan":"Z/ZAN, zanubrutinib.","ref1":"1. Niemann C, et al. ASH Annual Meeting; December 10-13, 2022; Abstract #93. 2. Tam C, et al.","oncol":"Lancet Oncol.","ref2":"2022;23(8):P1031-1043."},"summary":{"title":"Patient Resources (Saved Pages)","email":"Email","print":"Print","printNote":{"bold":"When printing:","text":"Please note that only the content currently displayed on the screen below will print. Ensure your preferred content is selected before printing."},"scan":"Scan QR code for saved summary pages","encouraged":"You are encouraged to share these resources with your caregivers","ifyoudlike":"If you would like to include all of the content for a particular agent, please select your agent(s) of interest below:"},"references":{"title":"References","cancerCare":" Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. Accessed December 18, 2021.","options":"StefaniukP, et al. Therapeutic Options for Patients with TP53 Deficient Chronic Lymphocytic Leukemia: Narrative Review.","cancerMgmt":"Cancer Management and Research","cancerMgmtCont":". 2021;13;1459-1476.","hallekM":"HallekM, et al. iwCLLguidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL.","blood":"Blood","hallekMCont":". 2018;131(25):2745-2760.","azPM":" AstraZeneca Canada Inc. Calquence (Acalabrutinib) Product Monograph.","azPMLink":"https://www.astrazeneca.ca/content/dam/az-ca/downloads/productinformation/calquence-product-monograph-en.pdf.","azPMassessed":" Accessed January 4, 2022.","byrd":"Byrd JC, et al. Acalabrutinib Versus Ibrutinib in Previously Treated Chronic Lymphocytic Leukemia: Results of the First Randomized Phase III Trial.","jclinoncol":"J Clin Oncol","byrdCont":". 2021;39(31):3441-3452.","coiffer":"Coiffer B, et al. Guidelines for the Management of Pediatric and Adult Tumor Lysis Syndrome: An Evidence-Based Review.","coifferCont":". 2008;26(16):2767-2778.","owenC":"Owen C, et al. Canadian evidence-based guideline for the first-line treatment of chronic lymphocytic leukemia.","currOncol":"CurrOncol","owenCcont":". 2018;25(5):e461-e474.","roche":" Roche Canada. Gazyva (Obinutuzumab) Product Monograph. https://www.rochecanada.com/PMs/Gazyva/Gazyva_PM_E.pdf. Accessed January 28, 2022.","sharman":"Sharman JP, et al. Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial.","lancet":"Lancet","sharmanCont":". 2020;395(10232):1278-1291.","janssen":" Janssen Inc. Imbruvica (Ibrutinib) Product Monograph. https://pdf.hres.ca/dpd_pm/00046525.PDF. Accessed January 28, 2022.","abbVie":" AbbVie Corporation. Venclexta (Venetoclax) Product Monograph. https://www.abbvie.ca/content/dam/abbvie-dotcom/ca/en/documents/products/VENCLEXTA_PM_EN.pdf. Accessed January 29, 2022.","alsawaf":"Al-Sawaf O, et al. Venetoclax plus obinutuzumab versus chlorambucil plus obinutuzumab for previously untreated chronic lymphocytic leukaemia (CLL14): follow-up results from a multicentre, open-label, randomised, phase 3 trial.","lancetOncol":"Lancet Oncol","alsawafCont":". 2020;21(9):1188-1200.","cancerCareOnt":" Cancer Care Ontario. FC+R Regimen. August 2020. https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf. Accessed February1, 2022","shadmanM":"Shadman M, et al. Debate: What Is Optimal First-Line Therapy for Chronic Lymphocytic Leukemia?","JNCCN":"JNCCN","shadmanCont":".2020;18(7.5):994-997. doi: 10.6004/jnccn.2020.5011."},"referencesCont":{"sharman":"Sharman JP, et al. Efficacy and safety in a 4-year follow-up of the ELEVATE-TN study comparing acalabrutinib with or without obinutuzumab versus obinutuzumab plus chlorambucil in treatment-naïve chronic lymphocytic leukemia.","leukemia":"Leukemia","sharmanCont":". 2022;36(4):1171-1175.","barrPM":"Barr PM, et al. Up to 8 Years Follow-up From RESONATE-2: First-Line Ibrutinib Treatment for Patients With Chronic Lymphocytic Leukemia.","bloodAdv":"Blood Adv","barrPMCont":". doi:10.1182/bloodadvances.2021006434.","alSawaf":"Al-Sawaf O, et al. Minimal Residual Disease Dynamics after Venetoclax-Obinutuzumab Treatment: Extended Off-Treatment Follow-up From the Randomized CLL14 Study.","jclinoncol":"J Clin Oncol","alSawafCont":". 2021;39(36):4049-4060.","alSawafVen":" Al-Sawaf O, et al. Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 4-year follow-up analysis of the randomized CLL14study. Presented at the European Hematology Association (EHA) Annual Meeting; June 11, 2021.","fisherK":" Fischer K, et al. Long-term remissions after FCR chemoimmunotherapy in previously untreated patients with CLL: updated results of the CLL8 trial. Blood. 2016;127(2):208-221.","zenT":"Zenz T, et al. TP53 mutation and survival in chronic lymphocytic leukemia.","zanTCont":". 2010;28(29):4473-4479.","cancerCareOntAcala":"Cancer Care Ontario. Acalabrutinib –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/63766. Accessed March 15, 2022.","cancerCareOntObinu":"Cancer Care Ontario. Obinutuzumab –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44386. Accessed March 15, 2022.","cancerCareIbru":" Cancer Care Ontario. Ibrutinib –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44366. Accessed March 15, 2022.","cancerCareVen":" Cancer Care Ontario. Venetoclax –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44476.Accessed March 15, 2022.","cancerCareFC":" Cancer Care Ontario. FC Regimen. https://www.cancercareontario.ca/en/system/files_force/FC_HEM_CLL.pdf?download=1. Accessed March 16, 2022.","rochePM":" Roche Canada. Rituxan (Rituximab) Product Monograph. https://www.rochecanada.com/PMs/Rituxan/RituxanIV_PM_E.pdf. Accessed March 16, 2022.","kotiah":"Kotiah SD, et al. Chronic Lymphocytic Leukemia Treatment Protocols.","drugs":"Drugs & Diseases","kotiahLink":" . https://emedicine.medscape.com/article/2005390-overview. Accessed February 8, 2022.","cancerCareIbruReg":"Cancer Care Ontario. IBRU Regimen. https://www.cancercareontario.ca/sites/ccocancercare/files/IBRU_HEM_CLL.pdf . Accessed February 8, 2022."},"referencesCont1":{"fischer":"Fischer K, et al. Venetoclaxand Obinutuzumab in Patients with CLL and Coexisting Conditions.","englj":"N Engl J Med","fischerCont":". 2019;380:2225-2236.","cancerVeneObin":" Cancer Care Ontario. VENE+OBIN Drug Formulary. https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/62876. Accessed February 7, 2022.","cdhta":" Canada’s Drug and Health Technology Agency. https://www.cadth.ca/reimbursement-review-reports. Accessed April 20, 2022.","lymphoma":"Lymphoma Canada. Frontline Therapy Provincial Drug Funding -Chronic Lymphocytic Leukemia (CLL) & Small Lymphocytic Lymphoma (SLL). https://www.lymphoma.ca/wp-content/uploads/2020/12/CLL-SLL-Provincial-Drug-Funding-Table.pdf. Accessed April 20, 2022.","canada":" Government of Canada. https://www.canada.ca/en/indigenous-services-canada/search/advanced-search.html. Accessed April 20, 2022","barrPM":" Barr PM, et al. Acalabrutinib±obinutuzumabversus obinutuzumab+chlorambucilintreatment-naïve chronic lymphocytic leukemia: Elevate-TN four-year follow-up. American Society of Clinical Oncology (ASCO) Annual Meeting; June 4-8, 2021 (ASCO Virtual Meeting). Poster# 7523.","woyach":"Woyach JA, et al. Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL.","woyachCont":". 2018;379(26):2517-2528.","morenoC":"Moreno C, et al. Ibrutinib plus obinutuzumabversus chlorambucil plus obinutuzumabin first-line treatment of chronic lymphocytic leukaemia (iLLUMINATE): a multicentre, randomised, open-label, phase 3 trial.","lancetOncol":"The Lancet Oncology","morecoCont":". 2019;20(1):P43-P56.","shanafelt":"Shanafelt TD, et al. Ibrutinib–Rituximab or Chemoimmunotherapy for Chronic Lymphocytic Leukemia.","shanafeltCont":". 2019;381:432-443."}}}],["$","div",null,{"className":"relative","children":[["$","main",null,{"className":"","children":["$","$Lb",null,{"parallelRouterKey":"children","segmentPath":["children",["lang","en","d"],"children"],"error":"$undefined","errorStyles":"$undefined","loading":"$undefined","loadingStyles":"$undefined","hasLoading":false,"template":["$","$Lc",null,{}],"templateStyles":"$undefined","notFound":"$undefined","notFoundStyles":"$undefined","asNotFound":false,"childProp":{"current":["$","$Lb",null,{"parallelRouterKey":"children","segmentPath":["children",["lang","en","d"],"children","get-started","children"],"error":"$undefined","errorStyles":"$undefined","loading":"$undefined","loadingStyles":"$undefined","hasLoading":false,"template":["$","$Lc",null,{}],"templateStyles":"$undefined","notFound":"$undefined","notFoundStyles":"$undefined","asNotFound":false,"childProp":{"current":["$Lf",null],"segment":"__PAGE__"},"styles":[]}],"segment":"get-started"},"styles":[]}]}],["$","$L10",null,{"id":"bg-main","className":"absolute left-0 top-0 -z-10 h-full min-h-screen w-full object-cover print:hidden","alt":"","src":{"src":"/_next/static/media/group-79.25d5adc9.svg","height":1337,"width":2057,"blurWidth":0,"blurHeight":0}}]]}],["$","$L11",null,{"lang":"en","dict":{"global":{"site":"This site is intended for Canadian Healthcare Professionals.","submit":"Submit","back":"Back","savePage":"Save Page","logo1":"Communicate & Collaborate","logo2":"in Chronic Lymphocytic Leukemia","click":"Click to reveal","discussionPoint":"If you have any questions or would like to know more about anything you see here, please ask.","filteringNote1":"Note: the ± symbol means “with or without”","filteringNote2":"Note: the + symbol means “with”","treatments":{"acala":"Acalabrutinib","zanu":"Zanubrutinib","ibru":"Ibrutinib","venSolo":"Venetoclax","ven":"Venetoclax + Obinutuzumab","chemo":"Chemo-immunotherapy","acalabrutinib":"Acalabrutinib","zanubrutinib":"Zanubrutinib","ibrutinib":"Ibrutinib","venetoclax":"Venetoclax","venetoclaxIbrutinib":"Venetoclax + ibrutinib","obinutuzumab":"Obinutuzumab"}},"email":{"body":"Here are some of the items we discussed during your visit.","subject":"Resources on your CLL treatment"},"login":{"role":"Role:","physician":"Physician","nurse":"Nurse","pharmacist":"Pharmacist","province":"Province:","license":"License:","licensePlaceholder":"Please enter your medical license number","consent":"As a Canadian healthcare professional, by clicking REGISTER, I Consent to the collection, use and disclosure of my personal information for the purposes identified or described in the","privacyLink":"Privacy Policy","consentCont":", if applicable, or otherwise at the time of collection.","rememberMe":"Remember me","submit":"Sign In"},"index":{},"filtering":{"submit":"Submit","insurance":{"select":"Please select your insurance options"},"province":{"select":"Please select your Province/Territory"}},"nav":{"legal":"Legal Notice","privacy":"Privacy Policy","cookie":"Cookie Policy","report":"Report Adverse Event","contact":"Contact Us","support":"If you need support, please contact Kristin Serodio with Bridge Medical Communications via email","phoneAt":"or phone at","reset":"Reset Tool","cover":"Home","introduction":"Why You Are Here","discuss":"Getting Ready to Start Treatment","treatment-plan-based":"Your Health Factors","options":"Treatment Options","options-tabs":"Treatment Considerations","oss-tabs":"Treatment Outcomes","side-effects":"Side Effects","dosing":"Dosing","schedule":"Treatment Schedules","logistics":"Treatment Logistics","funding":"Funding","summary-questions":"Summary Questions","trial-summaries":"Clinical Trial Summaries","summary":"Patient Resources (Saved Pages)","references":"References","":"External Resources"},"cover":{"title":"Decision Aid","subtitle":"This decision aid was created to help people with CLL like you decide which treatment option suits you and your cancer.","intro":"In this Decision Aid, you will:","learn":"Learn about the benefits and risks of different treatment options","find":"Find out how to manage potential treatment side effects and get help if you need it","discuss":"Discuss and decide with your healthcare team, which treatment option is best for you","caregivers":"Your caregivers are also encouraged to participate in these discussions","start":"Let’s get started","committee":"Scientific Planning Committee","development":"Development of the C³ Decision Aid was directed by a Scientific Planning Committee of a Canadian multi-disciplinary team of healthcare providers, hematologists, a nurse, and pharmacists"},"getStarted":{"title":"What Will Your Treatment Journey Look Like?","subtitle":"We will discuss your treatment journey and considerations along the way","card1":{"title":"Your CLL Treatment Options","goals":"Goals of Initial Conversation","find":"Find out why you are here","discuss":"Discuss your treatment journey and get ready to start treatment","learn":"Learn about how your health factors may affect your treatment","learnMore":"Learn more about your treatment options"},"card2":{"title":"Choosing and Starting Your Treatment","goals":"Goals of Follow-up Conversation","review":"Review what you learned","learn":"Learn more about:","considerations":"Treatment considerations","outcomes":"Treatment outcomes","effects":"Side effects to look out for","dosing":"Dosing","receiving":"Receiving your treatment","discussing":"Discussing treatment coverage"},"card3":{"title":"Continuing Your Treatment","text":"Following your treatment plan gives you the best chance of optimizing your quality of life and keeping your CLL under control"}},"onboarding":{"welcome":"Welcome to the C³ Decision Aid.","intro":"If this is your first time going through this Decision Aid, please follow this quick onboarding tutorial to get to know the interface.","continue":"Continue to onboarding","usedBefore":"I’ve used this Decision Aid before.","start":"Skip onboarding","section1":{"first":{"title":"Progress bar","text":"Keep track of where you are in the Decision Aid. This can be clicked to go back to the Journey page."},"second":{"title":"C³ Logo","text":"Go back home by clicking the logo. This is available on every page."},"third":{"title":"Menu Section","text":"Here you have different toggles to view content depending on your insurance, province or language. You also have access to the menu to jump to various sections of the Decision Aid."}},"section2":{"first":{"title":"Back Button","text":"Click the back button to go to the previous section of the decision aid."},"second":{"title":"Save Page","text":"This button allows you to save this page on the Patient Resources page. Once the page is saved, you can view all of your saved pages at the very end and either print or email the information straight to the patient."},"third":{"title":"Questions Button","text":"Some pages will have this button as a reminder to ask your patient specific questions based on the content of the page. Click here to activate the popup."},"fourth":{"title":"Next Page","text":"Done reviewing this content? Hit next to continue through the decision aid."}},"section3":{"first":{"title":"Stethoscope Icon","text":"Content marked with the stethoscope icon is meant for your (HCP) reference only."}},"finish":"Let's get started"},"introduction":{"title":"Introduction","subtitle":"Why we are here today:","chronic":" Chronic lymphocytic leukemia (CLL) is an ongoing (chronic), slow-growing cancer of the blood","blood":" Blood tests and other symptoms (such as fatigue and swollen lymph nodes) have confirmed progression","monitored":"Your CLL is regularly monitored and may not have needed treatment","discuss":"Let's discuss the next steps together","ref":"CLL = chronic lymphocytic leukemia"},"discuss":{"subtitle":"Discuss your treatment journey and get ready to start treatment:","CLL":"CLL cannot be cured but it can be treated","treatment":" For many patients, CLL treatment can keep the disease under control for extended periods","lets":"So, let’s discuss what a CLL treatment plan is based on…","ref":"CLL = chronic lymphocytic leukemia."},"treatmentPlanBased":{"click":"Click to reveal","subheading":"Your CLL treatment plan is based on:","age":"Your age and fitness","ageText":" Certain treatment options might be preferred depending on your age and your fitness level.","health":"Your overall health:","options":" Certain treatment options might be preferred depending on other conditions you might have (for example, a condition affecting your heart or blood vessels).","type":" The type of CLL you have and some specific characteristics of your disease","genetics":" Cytogenetic testing can help determine your best treatment option. This could be done with a blood or a bone marrow sample","fish":" FISH testing shows whether your cancer cells have certain mutations (changes) in their genetic material (DNA). For this test, a blood sample is collected","optionsMore":"Treatment options:","because":"Because of these factors, ","certain":"certain","optionss":" treatment options may be better able to:","keep":"keep your CLL under control","reduce":"reduce your symptoms","ref":" CLL = chronic lymphocytic leukemia; FISH = fluorescent in situ hybridization; DNA = deoxyribonucleic acid. "},"ways":{"1":"1. A fixed duration (1 - 2 years), or","2":"2. An indefinite duration (as long as the medication is still effective for you), or","3":"3. Until your healthcare team tells you otherwise.","title":"Ways to Receive Your CLL Treatment","subtitle":"Let’s look at how you will receive your treatment","pills":"Pills (by mouth, at home)","atHome":"You will take your medication at home","mustTake":"You must take your medication ","exactly":"exactly","asTold":" as your pharmacist or doctor tells you","byMouth":" You will need to take your medication by mouth on an empty stomach or with food and at the correct dose","for":"You may need to take your medication for:","intra":"Intravenous (IV)","clinic":"You will go to a hospital or outpatient clinic","nurse":" A nurse will put an IV (a soft, flexible tube) into a vein in your chest or in your arm","tube":"You will be given your medication through the tube","hours":"It may take minutes to hours to receive your entire dose","return":" You will need to return several times over a few months","pharma":"As your medication may react with food, remember to talk to your pharmacist about when to take it","ref":"IV = intravenous."},"options":{"title":"Your Treatment Options","heading":"Let’s discuss which treatment options are available to you based on your health, your disease, and your genetic testing results:","subheading":"Genetic Testing Results","testing":"If your testing shows that your cancer cells have any of the following, a targeted therapy might be a good choice for you:","listItem1":"An unmutated IGHV gene (the gene is not changed compared to other cells in your body)","listItem2":"One of the following mutations (changes in your DNA):","del":"del(17p)","or":"or","tp":"TP53","footnote1":"CLL = chronic lymphocytic leukemia; del(17p) = 17p deletion; IGHV = immunoglobulin heavy chain gene; IV = intravenous;","nowrap1":" TP53 = tumour protein p53.","footnote2":"1. Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. 2. Stefaniuk P, et al.","italic1":"Cancer Management and Research.","footnote3":" 2021:13;1459-1476. Walewska R, et al.","italic2":"Br J Haematol.","footnote4":"2022;197(5):544-557."},"optionsBest":{"title":"Your Treatment Options","heading":"Let’s discuss which treatment options are available to you based on your health, your disease, and your genetic testing results:","optionsAre":"Your options for treatment are:","targeted":"Targeted therapies including:","other":"Other non-targeted options include:","chemo":"Chemo-immunotherapy","fcr":"FCR (fludarabine / cyclophosphamide / rituximab)","types":"Types of treatments","capsules":"Capsules","tablets":"Tablets","iv":"IV = intravenous;","injection":"Injection","approved":" †Acalabrutinib is also approved for use with obinutuzumab (Gazyva®), though this combination is only publicly funded in Quebec.","leukemia":"CLL = chronic lymphocytic leukemia;","del":"del(17p) = 17p deletion;","ighv":"IGHV = immunoglobulin heavy chain gene;","tp":"TP53 = tumour protein p53.","footnote1":"1. Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. 2. Stefaniuk P, et al.","italic":"Cancer Management and Research.","footnote2":" 2021:13;1459-1476","modal":{"title":"2022 CARE™ CLL Treatment Guidance"}},"optionsReview":{"title":"Review of Treatment Options","heading":"Let's review what we have learned:","progression":"Disease progression","stage":"At what stage is your cancer?","steps":"What are the next steps in your treatment journey?","types":"Types of treatments","ivOnly":"IV only","ivTablets":"IV and tablets/capsules","tabletsOnly":"Tablets/capsules only","availableOptions":"Your available treatment options","targeted":"Targeted therapies","or":"Or","chemo":"chemo-immunotherapy","fcr":"FCR (fludarabine / cyclophosphamide / rituximab)","point":"If you have any questions or would like to know more about anything you see here, please ask.","approved":"†Acalabrutinib is also approved for use with obinutuzumab (Gazyva®), though this combination is only publicly funded in Quebec.","footnote1":"FCR = fludarabine/cyclophosphamide/rituximab; IV = intravenous. 1. Hallek M, et al.","italic1":"Blood","footnote2":". 2018;131(25):2745-2760. 2. Acalabrutinib PM. 3. Ibrutinib PM. 4. Venetoclax PM. 5. Obinutuzumab PM. 6. Zanubrutinib PM. 7. Owen C, et al. ","italic2":"Curr Oncol","footnote3":". 2018 Oct;25(5):e461-e474."},"treatmentConsiderations":{"title":"Treatment Considerations","heading":"Today, you will find out about:","consider":"Things to consider for each treatment option, including","benefits":"Benefits and risks of each treatment","outcomes":"Outcomes of each treatment option","manage":"How to manage side effects","team":"How your healthcare team will follow up with you and will monitor you on your treatment journey","receive":"How and when you will receive your treatment","ways":"Extra ways to receive care and support on your treatment journey","point":"If you have any questions about what you learn today, you can write them down and bring them to your next appointment."},"optionsTabs":{"title":"Things to Consider for Your Treatment Options","learnAbout":"Let’s learn about the benefits and risks of ","learnAbout2":"Let’s learn about the benefits and risks of ","acala":{"ref1":"CLL = chronic lymphocytic leukemia; TLS = tumour lysis syndrome; 1. Acalabrutinib PM. 2. Byrd JC, et al. ","ital1":"J Clin Oncol","ref2":". 2021;39(31):3441-3452. 3. Owen C, et al. ","ital2":"Curr Oncol","ref3":". 2018 Oct;25(5):e461-e474."},"zanu":{"ref1":"CLL = chronic lymphocytic leukemia. 1. Tam CS, et al. ","ital1":"Lancet Oncol.","ref2":"2022;23:1031-1043."},"ibrutinib":{"ref1":"CLL = chronic lymphocytic leukemia; TLS = tumour lysis syndrome; 1. Ibrutinib PM. 2. Owen C, et al. ","ital1":"Curr Oncol.","ref2":" 2018 Oct;25(5):e461-e474. 3. Byrd JC, et al.","ital2":"J Clin Oncol.","ref3":" 2021;39(31):3441-3452."},"obinutuzumab":{"ref1":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al.","ital2":"J Clin Oncol.","ref3":" 2008;26(16):2767-2778."},"venetoclaxObinutuzumab":{"ref1":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al. ","ital2":"J Clin Oncol. ","ref3":"2008;26(16):2767-2778."},"venetoclax":{"ref1":"CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","ital1":"Lancet Oncol.","ref2":"2020;21(9):1188-1200. 4. Coiffer B, et al. ","ital2":"J Clin Oncol. ","ref3":"2008;26(16):2767-2778."},"chemo":{"ref1":"CLL = chronic lymphocytic leukemia; FCR = fludarabine/cyclophosphamide/rituximab; IV = intravenous. 1. FCR_HEM_CLL.pdf. CCO Formulary August 2020. 2. Owen C, et al.","ital1":"Curr Oncol.","ref2":"2018;Oct;25(5):e461-e474. 3. Shadman M, et al. ","ital2":"JNCCN.","ref3":"2020;18(7.5):994-997. doi:10.6004/jnccn.2020.5011."},"venetoclaxIbrutinib":{"ref1":"CLL = chronic lymphocytic leukemia. 1. Kater AP, et al. ","ital1":"NEJIM Evid.","ref2":"2022;1:7. 2. Coiffer B, et al. ","ital2":"J Clin Oncol.","ref3":" 2008;26(16):2767-2778."}},"ossTabs":{"title":"Treatment Outcomes","learnAbout":"Let’s learn about the outcomes for each treatment","fourYears":"Four years","following":"after starting treatment, clinical trial researchers saw the following rates:","orr":"Overall response rate (ORR)","os":"Overall survival (OS)","pfs":"Progression-free survival (PFS)","more":"More data","definitions":{"def":"DEFINITION ","pfs1":"For patients who respond to treatment, this is the length of time before the cancer gets worse.","pfs2":"In a clinical trial, measuring PFS is a way to see how well a new treatment works.","pfsRef1":"1. National Cancer Institute. Available at:","pfsRefLink":"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/progression-free-survival.","pfsRef2":"Accessed March 15, 2022","orr1":" The percentage of people on a treatment who have a partial or complete response to the treatment within a certain period. A partial response means their tumour or tumours get smaller or in the amount of cancer in the body goes down. A complete response means that all signs of cancer in the body disappear.","orr2":" In a clinical trial, measuring the overall response rate is one way to see how well a new treatment works.","os1":" The length of time from either the date of cancer diagnosis or the start of cancer treatment that patients diagnosed with the disease are still alive.","os2":" In a clinical trial, measuring OS is a way to see how well a new treatment works.","osRef1":"1. National Cancer Institute. Available at:","osRefLink":"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/overall-survival.","osRef2":"Accessed March 15, 2022"},"zanu":{"twoYears":"Two years"},"ibru":{"six":"Six to seven years"},"ven":{"three":"Three to four years","noDifference":"No significant difference in OS","mayEndure":"Treatment response may endure","over":"Over 92%","patients":" of patients who were treated with ","didnot":"did not require","nextLine":" next-line therapy for ","threeOrMore":"3 or more years","after":" after treatment. Next-line therapy is given when a patient’s current treatment stops working"},"chemo":{"five":"Five years","following":"after starting treatment, clinical trial researchers saw the following rates in two types of chemo-immunotherapy (FCR and FC):","mutations":"If your CLL has no mutations in the IGHV gene or has del(17p) or TP53 mutations, chemo-immunotherapy may not be the best treatment option for you."},"venibru":{"learnAbout":"Let’s learn about the benefits and risks of ","three":"Three to four years","ref":" 1. Niemann CU, et al. Residual disease kinetics among patients with high risk factors treated with first line fixed duration ibrutinib plus venetoclax (Ibr+Ven) versus chlorambucil plus Obinutuzumab (Clb+O): the GLOW study. Presented at the American Society of Hematology Annual Meeting; December 10, 2022."},"refs":{"acala1":"*The rate for patients taking acalabrutinib+obinutuzumab was","acala2":"ORR = overall response rate; OS = overall survival; PFS = progression-free survival. 1. Sharman JP, et al. ","ital1":"Leukemia. ","acala3":"2022;36:1171-1175.","zanu1":"*The rate for patients with del(17p) was ","orr":"ORR = overall response rate;","os":"OS = overall survival;","pfs":"PFS = progression-free survival;","zan2":"1. Tam CS, et al. ","zanItal1":"Lancet Oncol.","zanu3":"2022;23:1031-1043.","ibru1":" *These benefits were similar in patients with high-risk CLL (TP53 mutation; unmutated IGHV disease but excluding del(17p)). CLL = chronic lymphocytic leukemia; del(17p) = deletion (17p); IGHV = immunoglobulin heavy chain gene; OS = overall survival; PFS = progression-free survival; TP53 = TP53 protein. 1. Barr PM, et al. ","ibruItal1":"Blood Adv.","ibru2":"doi:10.1182/bloodadvances.2021006434.","ven":" *CLL14 12-month fixed-duration VEN-OBI: 3+ YEAR FOLLOW-UP – OS and PFS were estimated to 4 years. CLL = chronic lymphocytic leukemia; OBI = obinutuzumab; OS = overall survival; PFS = progression-free survival. 1. Al-Sawaf O, et al. ","venItal1":"The Lancet Oncol.","ven2":"2020;21(9):P1188-P1200. doi:10.1016/S1470-2045(20)3043-5. 2. Al-Sawaf O, et al.","venItal2":"J Clin Oncol.","ven3":" 2021;39(36):4049-4060. doi:10.1200/JCO.21.01181. 3. Al-Sawaf O, et al. Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 4-year follow-up analysis of the randomized CLL14 study. Presented at the European Hematology Association Annual Meeting; June 11, 2021. ","chemo":" *CLL8 5.9-year Follow-up. †The OS rate of patients with mutations in the IGHV gene was 86% with FCR and 80% with FC after 5 years. CLL = chronic lymphocytic leukemia; del(17p) = deletion(17p); FC = fludarabine-cyclophosphamide; FCR = fludarabine-cyclophosphamide-rituximab; OS = overall survival; PFS = progression-free survival; TP53 = TP53 protein. 1. Fischer K, et al. ","chemoItal1":"Blood.","chemo2":" 2016;127(2):208-215. 2. Zenz T, et al. J Clin Oncol. 2010;28(29):4473-4479.","venibru":" 1. Niemann CU, et al. Residual disease kinetics among patients with high risk factors treated with first line fixed duration ibrutinib plus venetoclax (Ibr+Ven) versus chlorambucil plus Obinutuzumab (Clb+O): the GLOW study. Presented at the American Society of Hematology Annual Meeting; December 10, 2022. "}},"sideEffects":{"title":"Side Effects","what":"What is a side effect?","a":"A","treatment":"treatment side effect","is":"is a","symptom":"symptom","happens":"that happens due to a drug. Side effects may occur at any dose","know":" We know that these side effects can happen because of familiarity with these drugs","most":"Most","sideEffects":"treatment side effects","may":"may lessen after some time as your body becomes used to the medication","needed":" If needed, lowering the amount of medication you take or stopping the medication may reduce or stop the treatment side effect","discuss":"Always discuss discontinuing or lowering your dose with your doctor","first":"first","before":"before making any changes","lets":"Let’s discuss","so":", so you know:","expect":"What to expect during your treatment","how":"How to manage the side effects when/if they happen"},"sideEffectsTabs":{"title":"Side Effects","whatYouCanDo":" Here’s what you can do at home to try to prevent or manage certain side effects: ","tips":"Tips for Managing Your Side Effects","tipsAtHome":"Managing Side Effects at Home","monograph":"Product Monograph","very":"Very common","veryPeople":"50 or more out of 100 people","common":"Common","commonPeople":"25 to 49 out of 100 people","less":"Less Common","lessPeople":"10 to 24 out of 100 people","talk":"Talk to your doctor if you have any of these symptoms:","acala":{"tips":"","very":"Very common","captionVery":"50 or more out of 100 people","infections":"Infections*","common":"Common","people":"25 to 49 out of 100 people","bleeding":"Bleeding or bruising (common); low platelets in the blood (less common)","headache":"Headache","muscle":"Mild joint or muscle pain or cramps","diarrhea":"Diarrhea","less":"","lessPeople":"","lessList":{"nausea":"Nausea and throwing up (usually mild)","liver":" Liver problems","rash":"Rash and dry, itchy skin","tiredness":"Tiredness","low":"Low white blood cell counts","dizziness":"Dizziness","constipation":"Constipation","high":"High blood pressure","atrial":"Atrial fibrillation","cancer":"Cancer cells dying quickly when you start treatment (in severe cases TLS can happen, which may impact how well your organs work)"}},"tipsForHome":{"refs1":{"acala":"1. Acalabrutinib PM.","zanu":"1. Zanubrutinib PM.","ibru":"1. Ibrutinib PM.","ven":"1. Venetoclax PM.","chemo":"1. Rituximab PM. 2. Fludarabine PM."},"acala":{"toHelp":"To help prevent","infections":"infections","precautions":"Take certain precautions (eg, handwashing, mask wearing)","makeSure":"Make sure you and your close contacts are up - to - date on vaccinations","helpManage":"To help manage","headaches":"headaches","takeCaffeine":"Take caffeine (eg, coffee); if your headache doesn't go away, talk to your healthcare provider about medications you can take to manage your headache. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","aid":"To help manage","diarrhea":"diarrhea","increase":"Increase your intake of clear fluids (non-caffeinated, non-alcoholic, non-carbonated)","eatSmaller":"Eat smaller and more frequent meals consisting of low-fibre, high-calorie foods, like the BRAT (bananas, rice, applesauce, toast) diet ","avoid":"Avoid foods high in fat, sugar, and lactose, as well as acidic, spicy, or gas-producing foods","ask":"Ask your doctor about taking medications to help with diarrhea","helpManageAndPrevent":"To help manage and prevent","joint":"joint or muscle pain","talk":"Talk to your healthcare provider about medications you can take to manage your pain. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","stretching":"Do stretching and strengthening routines","apply":"Apply hot and/or cold compresses as needed","water":"Drink a lot of water","drinkTonic":"Drink tonic water in the evening to reduce muscle cramping at night","change":"Change your plans to lighten your load","ref1":"1. Banerji V, et al. Curr Oncol. 2020;27(6):e645-e655.","ref2":"2. Government of Canada. Immunization of immunocompromised persons: Canadian Immunization Guide. Dec 24, 2020. ","ref3":"3. Herishanu Y, Perry C. Blood. 2021;138(18):1652-1653.","ref4":"4. Diarrhea. Canadian Cancer Society website. ","link":"https://cancer.ca/fr/treatments/side-effects/diarrhea.","assessed":"Accessed April 29, 2022.","ref5":"5. Nierman P. Clin J Oncol Nurs. 2021;25(6):687-696.","ref6":"6. Cleveland Clinic website. Musculoskeletal Pain.","ref6Link":"https://my.clevelandclinic.org/health/diseases/14526-musculoskeletal-pain.","asessed6":"Accessed April 29, 2022. ","ref7":"7. Badillo M, et al. Clin J Oncol Nurs. 2022;24:392-398."},"zanu":{"toHelp":"To help prevent","infections":"infections","precautions":"Take certain precautions (eg, handwashing, mask wearing)","makeSure":"Make sure you and your close contacts are up - to - date on vaccinations","helpManage":"To help manage","headaches":"headaches","takeCaffeine":"Take caffeine (eg, coffee); if your headache doesn't go away, talk to your healthcare provider about medications you can take to manage your headache. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","aid":"To help manage","diarrhea":"diarrhea","increase":"Increase your intake of clear fluids (non-caffeinated, non-alcoholic, non-carbonated)","eatSmaller":"Eat smaller and more frequent meals consisting of low-fibre, high-calorie foods, like the BRAT (bananas, rice, applesauce, toast) diet ","avoid":"Avoid foods high in fat, sugar, and lactose, as well as acidic, spicy, or gas-producing foods","ask":"Ask your doctor about taking medications to help with diarrhea","helpManageAndPrevent":"To help manage and prevent","joint":"joint or muscle pain","talk":"Talk to your healthcare provider about medications you can take to manage your pain. If they direct you to take acetaminophen, always check your temperature before taking it. Avoid long-acting forms of acetaminophen","stretching":"Do stretching and strengthening routines","apply":"Apply hot and/or cold compresses as needed","water":"Drink a lot of water","drinkTonic":"Drink tonic water in the evening to reduce muscle cramping at night","change":"Change your plans to lighten your load"}},"zanu":{"lowSugar":"Low blood sugar*","lowBlood":"Low blood cell counts*","muscle":"Muscle or joint pain*","upper":"Upper respiratory tract infection*","bleeding":"Bleeding*","rash":"Rash*","bruising":"Bruising","abnormalKidney":"Abnormal kidney lab tests*","abnormalLiver":"Abnormal liver lab tests*","cough":"Cough","highBlood":"High blood pressure*","diarrhea":"Diarrhea*","pneumonia":"Pneumonia*","tiredness":"Tiredness*","another":"Another type of cancer*","headache":"Headache","dizziness":"Dizziness*","constipation":"Constipation*","nausea":"Nausea","atrial":"Atrial fibrillation†"},"ibru":{"higher":"Higher than normal white blood cell counts","diarrhea":"Diarrhea","headache":"Headache","muscle":"Mild joint or muscle pain or cramps","tiredness":"Tiredness","high":"High blood pressure","low":"Low appetite (not wanting to eat)","cough":"Cough and feeling short of breath","nausea":"Nausea and throwing up","rash":"Rash and dry, itchy skin","swelling":"Mild swelling","eye":"Eye problems*","constipation":"Constipation","infections":"Infections (incl. pneumonia, skin infections)","lowWhite":"Low white blood cell counts*","atrial":"Atrial fibrillation"},"ven":{"low":"Low white blood cell counts*","platelets":"Low platelets in the blood*","allergic":"Allergic reaction*","diarrhea":"Diarrhea","nausea":"Nausea and throwing up (usually mild)","tiredness":"Tiredness","headache":"Headache","mild":"Mild joint or muscle pain or cramps","fever":"Fever, chills, infection*","liver":"Abnormal liver lab tests*","kidney":"Abnormal kidney lab tests*","bleeding":"Bleeding*","cough":"Cough and feeling short of breath","swelling":"Mild swelling","cramps":"Pain or cramps in the belly","rash":"Rash and dry, itchy skin","salt":"Too much or too little salt in your body","constipation":"Constipation","dizinness":"Dizziness","mouth":"Mouth sores","tls":"TLS (cancer cells dying quickly when you start treatment, which might impact how well your organs work)"},"chemo":{"one":"Myelosuppression (when fewer blood cells are made) with or without bleeding","infection":"Infection","nausea":"Nausea/throwing up, diarrhea, refusing to eat","fever":"Fever","liver":"Abnormal liver lab tests","tiredness":"Tiredness","rash":"Rash*","vision":"Changes in vision","bladder":"Inflamed bladder","fertility":"Risk to fertility and the ability to have children","autoimmune":"Autoimmune disorders","brain":"Encephalopathy (a brain disorder), seizures, feeling confused or agitated","lungs":"Inflamed lungs","heartFailure":"Heart failure, irregular heartbeat","clots":"Blood clots","siadh":"SIADH (a disorder that causes too little salt in the body)","dic":"DIC (a disorder of the proteins that help blood to clot)","cancer":"Developing a secondary cancer","vod":"VOD, HUS (disorders affecting blood flow to the liver and kidneys)","tls1":"Tumour lysis syndrome (TLS; TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work)","kidney":"Kidney failure","pancreas":"Inflamed pancreas","rhab":"Rhabdomyolysis (a syndrome where muscles break down)","graft":"Transfusion-associated graft-versus-host disease (when transfused blood components attack the patient’s body due to chemotherapy’s immune effects)","bleeding":"Bleeding issues","heartIssues":"Heart issues (including irregular heartbeat, chest pain)","weakness":"Weakness, memory problems, changes in vision, mood changes, loss of speech, numbness","hepat":"Hepatitis B infection","shingles":"Shingles","infusion":"Infusion-related reactions (fever and chills, nausea, throwing up, skin rash, swelling, difficulty breathing)","redness":"Redness, blisters on skin and/or mouth","kidneyProblems":"Kidney problems (may see swelling, side/back pain)","tls":"TLS"},"refs":{"maybe":"*May be severe","less":"†Less common than 10%","tls":"TLS = tumour lysis syndrome; PM = product monograph","cancerCare":"1. Cancer Care Ontario. Acalabrutinib – Patient Info Sheet. Available at:","cancerCareLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/63766.","assessed":"Accessed March 15, 2022. 2. Coiffer B, et al. ","oncol":"J Clin Oncol.","oncol2":" 2008;26(16):2767-2778.","acala":"3. Acalabrutinib PM. 4. Byrd JC, et al. ","lancet":"Lancet Oncol.","acala2":"2021;39(31):3441-3452.","zanu":"1. BRUKINSA PM. 2. Tam CS, et al. ","zanu2":"2022;23:1031-1043.","pm":"PM = product monograph.","ibru":"1. Cancer Care Ontario. Ibrutinib –Patient Info Sheet. Available at:","ibruLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44366.","ibruAcessed":"Accessed: March 15, 2022. 2. Ibrutinib PM.","obinu":" CLL = chronic lymphocytic leukemia; IV = intravenous; TLS = tumour lysis syndrome. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Al-Sawaf O, et al. ","obinu2":" 2020;21(9):1188-1200. 4. Coiffer B, et al.","obinu3":"2008;26(16):2767-2778.","venTLS":"TLS = tumour lysis syndrome","ven1":" 1. Cancer Care Ontario. Venetoclax –Patient Info Sheet. Available at:","venLink":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44476.","venAssessed":" Accessed: March 15, 2022. 2. Cancer Care Ontario. Obinutuzumab –Patient Info Sheet.","venLin2":"https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44386.","venAssessed2":"Accessed: March 15,2022. 3. Coiffer B, et al.","ven3":"2008;26(16):2767-2778.","chemo1":" CNS = central nervous system; DIC = disseminated intravascular coagulation; FC = fludarabine/cyclophosphamide; HUS = hemolytic uremic syndrome; SIADH = syndrome of inappropriate antidiuretic hormone; TLS = tumour lysis syndrome; VOD = veno-occlusive disease.","cancerCareFC":"1. Cancer Care Ontario FC Regimen","chemo2":"https://www.cancercareontario.ca/en/system/files_force/FC_HEM_CLL.pdf?download=1.","chemoAssessed":"Accessed: March 15, 2022. 2. Rituximab Product Monograph 3. Coiffer B, et al.","chemo3":"2008;26(16):2767-2778.","venibru":" CLL = chronic lymphocytic leukemia. 1. Kater AP, et al.","evid":"NEJIM Evid.","venibru2":"2022;1:7. 2.","veinbru3":" Coiffer B, et al.","veinbru4":"2008;26(16):2767-2778.","obinuModal":{"ref1":"1. Cancer Care Ontario. Obinutuzumab –Patient Info Sheet. Available at:.","ref1Asessed":"Accessed : March 15, 2022."},"venibruModal":{"pms":"1. VENCLEXTA PM. 2. IMBRUVICA PM. 3. KaterAP, et al."}}},"dosing":{"title":"Dosing","keep":"As you receive your treatment, here are some things your healthcare providers and you need to keep in mind:","acala":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":"Take your acalabrutinib tablets exactly as your healthcare professional tells you. If you are on 2 tablets a day, take them about 12 hours apart","same":"Take about the same time each day","with":"Take with or without food","swallo":" Swallow them whole with a glass of water. Do not chew, crush, dissolve, or divide the tablets","bold1":"Do not","takeCertain":" take certain medications called strong or moderate CYP3A4 and/or CYP3A4 inducers. A few examples are:","inhibitors":"Inhibitors: Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","inducers":" Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","discuss":" Discuss with your doctor the benefits and risks of stopping acalabrutinib for at least 3 days before and after having surgery","talk":"Talk to your healthcare provider if you have","bleeding":"bleeding problems, or before you plan on taking medicines that may increase your risk of bleeding,","including":"including:","aspirin":"aspirin and anti-inflammatories such as ibuprofen or naproxen","thinners":"blood thinners such as warfarin, heparin or other medicines to treat or prevent blood clots such as dabigatran, rivaroxaban, apixaban","supplements":"supplements such as fish oil, vitamin E and flaxseed"},"zanu":{"take":"Take your zanubrutinib capsules exactly as your healthcare professional tells you.","swallow":"Swallow them whole with a glass of water. Do not open, break, or chew the capsules","bold1":"Do not","takeCertain":"take certain medications called strong or moderate CYP3A4","inducers":"inducers.","examples":"A few examples are:","gloc":"Some glucocorticoids, anti-seizure medications, St. John’s Wort","caution":"Take caution","strong":" with certain medications called strong or moderate CYP3A","inhibitors":"inhibitors","doctor":". Your doctor will give you a lower dose of zanubrutinib. A few examples are:","antifungals":" Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","discuss":"Discuss with your doctor the benefits and risks of stopping zanubrutinib for at least 3 days before and after having surgery","talk":"Talk to your healthcare provider if you have","bleeding":" bleeding problems, or before you plan on taking medicines that may increase your risk of bleeding,","including":" including:","aspirin":"aspirin and anti-inflammatories such as ibuprofen or naproxen","thinners":" blood thinners such as warfarin, heparin or other medicines to treat or prevent blood clots such as dabigatran, rivaroxaban, apixaban","supplements":"supplements such as fish oil, vitamin E and flaxseed"},"ibru":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":" Take your ibrutinib capsules by mouth once per day","swallow":" Swallow them whole with a glass of water","donot":" Do not open, crush, or chew the capsules","takeSame":" Take your ibrutinib capsules at about the same time each day","bold1":"Do not","grape":"take your ibrutinib capsules with grapefruit juice or fish oils","strong":" take certain medications called strong CYP3A4","inhibitors":" inhibitors","and":"and/or CYP3A4","inducers":" inducers","examples":". A few examples are:","inhibitorsEx":" Inhibitors: Certain antifungals, antibiotics, certain COVID-19 treatments (for example, nirmatrelvir + ritonavir), blood pressure medications, grapefruit juice","inducersEx":" Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","if":" If you have moderate or severe liver problems, you should not take ibrutinib","let":"Let your healthcare provider know if","unusual":" you have unusual bleeding or bruising or plan on taking any medicines that may increase your risk of bleeding,","such":" such as:","aspirin":" Aspirin, anti-inflammatories (e.g., ibuprofen, naproxen, and others), warfarin, heparin, other medications to prevent or treat blood clots (e.g., dabigatran, rivaroxaban, apixaban), or any supplements that increase your risk of bleeding such as fish oil, flaxseed, or vitamin E","discuss":"Discuss with your doctor the benefits and risks of stopping ibrutinib at least 3 days before and after surgery"},"ven":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","while":" While receiving venetoclax treatment, you are at risk of developing tumour lysis syndrome (TLS). TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work, and requires hospitalization","when":" When you first start your venetoclax treatment, you need to be monitored closely in hospital with frequent blood work to look for signs of TLS","healthcare":"Your healthcare team will assess your risk of TLS","if":"If you are prescribed allopurinol, it is important to stay hydrated","should":"You should receive obinutuzumab as an","iv":"IV infusion only","shouldReceive":" You should receive 9 infusions in a hospital or other location where equipment is available for life-saving action in the event of an emergency","doctor":"An experienced doctor should care for you or supervise your care","infusion":"Obinutuzumab infusions should","not":"not","beGiven":" be given too quickly (this is called a bolus or push)","kidney":"If you have kidney problems, you may experience more side effects. These side effects could include TLS"},"chemo":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","usually":" Usually, you will receive a total of six (6) chemotherapy cycles unless your cancer gets worse, or the side effects become too difficult for you","if":" If your blood test results show that your white blood cell and platelet counts are too low after one cycle, your next cycle may start one week later than scheduled","if2":" If your blood tests continue to show low white blood cell and platelet counts, or you develop a major infection, your dose of two of your chemotherapy drugs (fludarabine and cyclophosphamide) will be lowered","if3":"If you are at a higher risk for tumour lysis syndrome (TLS), you will take another medication to help prevent TLS.","if4":"TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","treatment":" Your treatment may be different based on your age and on your genetic testing results","not":"Chemo-immunotherapy with FCR is not recommended for patients with ","del":"del(17)p","mutations":"mutations","instead":"Instead, the recommended treatments to start with are:","acala":"Acalabrutinib ± obinutuzumab","ibru":"Ibrutinib","ven":"Venetoclax + obinutuzumab"},"obinu":{"report":"Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","should":"You should receive obinutuzumab as an","iv":"IV infusion only","shouldReceive":" You should receive it in a hospital or other location where equipment is available for life-saving action in the event of an emergency","obinuShould":"Obinutuzumab infusions should","not":"not","beGiven":"be given too quickly (this is called a bolus or push)","kidney":" If you have kidney problems, you may experience more side effects, which could include tumour lysis syndrome (TLS; TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work)"},"venibru":{"report":" Report any medication changes to your healthcare team. This helps to ensure there are no drug interactions with your treatment.","take":"Take your ibrutinib capsules by mouth once per day ","swallow":"Swallow them whole with a glass of water","donot":" Do not open, crush, or chew the capsules","takeSame":"Take your ibrutinib capsules at about the same time each day","bold1":"Do not","grape":"take your ibrutinib capsules with grapefruit juice or fish oils","strong":" take certain medications called strong CYP3A4","inhibitors":" inhibitors","and":"and/or CYP3A4","inducers":" inducers","examples":". A few examples are:","inhibitorsEx":"Inhibitors: Certain antifungals, antibiotics, blood pressure medications, grapefruit juice","inducersEx":"Inducers: Some glucocorticoids, anti-seizure medications, St. John’s Wort","if":" If you have moderate or severe liver problems, you should not take ibrutinib","while":"While receiving venetoclax treatment, you are at risk of developing tumour lysis syndrome (TLS). TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work, and requires hospitalization","when":"When you first start your venetoclax treatment, you need to be monitored closely in hospital with frequent blood work to look for signs of TLS","healthcare":"Your healthcare team will assess your risk of TLS"},"refs":{"acala1":"CYP3A4 = cytochrome P450 3A4; IV = intravenous; PPI = proton pump inhibitors;","acala2nowrap":"TLS = tumour lysis syndrome.","acala3":"1. Acalabrutinib PM.","acala4":"2. Obinutuzumab PM. 3. Coiffer B, et al.","acalaItal":"J Clin Oncol.","acala5":"2008;26(16):2767-2778.","zanu":"CYP3A4 = cytochrome P450 3A4. 1. BRUKINSA PM.","ibru":"CYP3A4 = cytochrome P450 3A4; PM = product monograph. 1. Ibrutinib PM.","ven1":" IV = intravenous; PM = product monograph; TLS = tumour lysis syndrome. 1. Venetoclax PM.","ven2":" 2. Obinutuzumab PM. 3. Coiffer B, et al.","venItal":"J Clin Oncol.","ven3":"2008;26(16):2767-2778.","chemo1":"del(17p) = deletion 17p; FCR = fludarabine/cyclophosphamide/rituximab;","chemo2nowrap":"TLS = tumour lysis syndrome.","chemo3":"1. Cancer Care Ontario. FC+R Regimen. August 2020.","chemo4break":"https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf.","chemo5":"Accessed Feb 8, 2022.","chemo6":" 2. Kotiah SD, et al. Drugs & Diseases. Accessed February 8, 2022.","chemo7break":"https://emedicine.medscape.com/article/2005390-overview.","chemo8":"3. Coiffer B, et al. J Clin Oncol. 2008;26(16):2767-2778."}},"schedule":{"title":"Treatment Schedule","lets":"Let’s compare the schedules for each treatment choice.","calendar":" This calendar shows when you will receive your medication.","calendars":"These calendars show when you will receive your medications.","available":"Available as an outpatient prescription, which means you take it at home","morning":"Morning","everyDay":"every day","evening":"Evening","once":"Once","or":"or","everyDay2":"every day","continueUntillDifficult":"Continue taking it unless your cancer gets worse or the side effects become too difficult for you","another":"Another treatment may be required","nausea":"for nausea or throwing up","if":"If you experience nausea and vomiting, your doctor may prescribe you a medication (an antiemetic) to help manage these symptoms","risk":"If you are at risk for a side effect called tumour lysis syndrome (TLS), your physician will monitor you closely and may decide to give you a treatment to help prevent it","tls":"TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","infections":"If you are at risk for certain infections, your physician may decide to give you a treatment to help prevent them","day12815":"Day 1, 2, 8, 15","atleast4":"(at least 4 hours for infusion)","day22":"Day 22","start":"Start ramp-up","dose":"Dose increases weekly until week 5","day1":"Day 1","everyCycle":"every cycle;first cycle will be lower dose (4 hours for infusion)","everyCycle2":"every cycle","EveryDay":"Every day","takenFor5":"Taken on Day 1 for 5 cycles (6 total)","continue12thCycle":"Continue until the end of the 12th cycle unless your cancer gets worse or the side effects become too difficult for you","continue15thCycle":"Continue until the end of the 15th cycle unless your cancer gets worse or the side effects become too difficult for you","startUntill5":"Start ramp-up dose increases weekly until week 5","cycle1IV":"Cycle 1 given by IV, cycles 2–6 given by a needle (subcutaneously [under the skin])","day12345":"Day 1, 2, 3, (4 & 5)","mostTake":"Most patients take this medication on days 1–3 of each cycle, while some take it on days 1–5","ifReq":"If required","forNausea":"for nausea or throwing up","forTLS":"for TLS and infection prevention","monitor":"Your healthcare team will monitor you closely to help prevent tumour lysis syndrome (TLS).","tlsCanHappen":" TLS can happen when you start treatment, and your cancer cells die too quickly; it may impact how well your kidneys and other organs work","note":"Note: This is an example of how you may receive this treatment. A doctor who is trained in the use of chemotherapy will give this treatment. ","mayAdjust":"They may adjust the treatment depending on how your body tolerates the medications.","ref1":"IV = intravenous; PM = product monograph. 1. Acalabrutinib PM. 2. Obinutuzumab PM.","ref1Zanu":"PM = product monograph. 1. BRUKINSA PM.","ref2":"PM = product monograph; TLS = tumour lysis syndrome. 1. Ibrutinib PM. 2. Cancer Care Ontario. IBRU Regimen. ","ref2Link":"https://www.cancercareontario.ca/sites/ccocancercare/files/IBRU_HEM_CLL.pdf.","ref2Assessed":"Accessed: February 8, 2022.","ref3":"3. Coiffer B, et al. ","ref3Ital":"J Clin Oncol.","ref3cont":"2008;26(16):2767-2778.","ref4":"VEN = venetoclax. 1. Venetoclax PM. 2. Obinutuzumab PM. 3. Fischer K, et al.","ref4ital":"N Engl J Med.","ref4cont":"2019;380:2225-2236. 4. Cancer Care Ontario. VENE+OBIN Drug Formulary.","ref4Link":"https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/62876.","ref4accessed":"Accessed: Feb 7, 2022.","ref5chemo":"IV = intravenous; PM = product monograph; TLS = tumour lysis syndrome. 1. Cancer Care Ontario. FC+R Regimen. August 2020.","ref5chemoLink":" https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf. ","ref5chemoAssessed":" Accessed Feb 8, 2022. 2 Rituximab PM. 3. Coiffer B, et al. J Clin Oncol. 2008;26(16):2767-2778."},"logistics":{"title":"Logistics for Receiving Your Treatment","gettingToHospital":"Getting to the hospital/infusion centre","IVsupport":"Support for IV infusion visits","multipleVisits":"Multiple healthcare provider visits","waitTimes":" Wait times for infusions and hospital beds","doctorWillMonitor":" Your doctor will need to monitor you (in-person) for some side effects","addmitted":"May need to be admitted to the hospital for TLS due to venetoclax","addmittedChemo":"May need to be admitted to the hospital for TLS due to chemo","eachCycle":"*Each cycle is 28 Days","waitTimes2":"Wait times for infusions / hospital beds","ivTLS":" IV = intravenous; TLS = tumour lysis syndrome."},"funding":{"title":"Funding for Previously Untreated CLL by Province","approval":"Health Canada Approval","recommendation":"Recommendation","NIHB":"NIHB","reimburseCond":"Reimburse with clinical criteria and/or conditions","underReview":"Under reimbursement review","refa":" a For the treatment of patients with previously untreated CLL for whom a fludarabine-based regimen is inappropriate.","refb":"b First-line tx of pts with CLL and a CIRS ≤6.","refc":"c ± Obinutuzumab","refd":"d Limited use benefit (prior approval required).","cirs":" CIRS = cumulative illness rating scale;","cll":" CLL = chronic lymphocytic leukemia;","nihb":" NIHB = Non-Insured Health Benefits Program;","pts":" pts = patients; tx = treatment.","link1":"1. https://www.cadth.ca/reimbursement-review-reports.","link2":"2. https://www.lymphoma.ca/wp-content/uploads/2020/12/CLL-SLL-Provincial-Drug-Funding-Table.pdf.","link3":" 3. https://www.canada.ca/en/indigenous-services-canada/search/advanced-search.html;"},"summaryQuestions":{"title":"Summary Questions to Ask","lets":" Let’s review the following questions to make sure you and your caregiver(s) understand what was discussed","believe":" Do you believe that you have a good understanding of the Treatment Options available to treat your CLL?","areyou":"Are you and your caregiver(s) satisfied that you have enough information to select a treatment option if not today, then at the next visit?","support":"Do you believe that your support team understands how they may help you once you start your treatment journey?","other":"Are there any other questions that you would like to ask me today?","think":"If you think of any questions regarding your treatment journey,","write":"please write them down","discuss":" we will discuss them next time."},"trialSummaries":{"title":"Clinical Trial Summaries","treatment":"Treatment","name":"Trial name","design":"Trial design","population":"Population","outcomes":"Primary outcomes","secondary":"Select secondary outcomes","safety":"Safety","other":"Other safety comments","elevate5follow":"ELEVATE-TN 5-Yr Follow-up","acalobin":"ACAL ±OBIN vs OBIN + Clb","phase3":"Phase 3, multi-centre,","openLabel":"open label","ptsAged":"Pts aged ≥65 years or","crcl":"18-64 years with CrCl< 70 mL and/or CIRS-G score >6","medianPFS":"Median PFS:","nrao":"NR (A + O) vs NR (A) vs 27.8 mos (O + Clb) (","P":"P","<0":"<0.0001)","estPFS60":"Est. PFS at 60 mos:","84%":"84% (A + O) vs 72% (O)","vs21%":"vs 21% (O + Clb)","estimatedOS60":"Estimated OS at 60 mos: ","90%ao":"90% (A + O) vs 84% (A), vs 82% (O + Clb)","odr":"ODR:","35%ao":"35% (A + O), 40% (A), and 23% (O + Clb)","mostCommonReasons":"Most common reasons:","AEs":"AEs: (17% [A + O], 16% [A], 14% [O + Clb])","pdao":"PD: (6% [A + O], 10%[A], 2% [O + Clb])","safetyAO":"Safety of A + O and A mono-therapy maintained","ibru":"I = ibrutinib;","resonate2":"RESONATE 2","8yrFollowUp":"8-Yr Follow-up","ibrVSclb":"IBR vs Clb","phase3RCT":"Phase 3, RCT, double-blind, multi-centre, open label","ptsAged65":"Pts aged ≥65 years","without":"without","del(17p)":"del(17p)","neVS15":"NE vs 15.0 mos (HR 0.16; 95% CI .11-0.23)","estPFSat7yrs":"Est. PFS at 7 years:","59%I":"59% (I) vs 9% (Clb)","estOSibr":"Est. OS for IBR at 7 years:","78%":"78%","grade>3":"Grade ≥3 infectious complications:","hyper12%":"Hypertension: 12% Afib: 6%","grade>3hemor":"Grade ≥3 major hemorrhage: 7%","8yrFollow":"8-year follow-up:","noSafetySignals":"no new safety signals","alliance":"ALLIANCE A041202","ibr+rtx":"IBR + RTX vs. BEN + RTX","phase3RCTsolo":"Phase 3, RCT","reachedOnlyBen":"reached only with BEN + RTX","est24mPFS":"Est. 24-mos PFS:","74%brI":"74% (BR) vs 87% (I) vs 88% (I+R)","os":"OS:","noSigDifference":"No significant difference among the three treatment groups","grade3hema":"Grade ≥3 hematologic AEs:","61BRI":"61% (BR) vs 14% (I)","vs39":"vs 39% (I+R)","grade3nonhema":"Grade ≥3 nonhematologic AEs","63%BRIbru":": 63% (BR) vs 74% (I/I+R)","n/a":"N/A","iLL":"iLLUMINATE","ibrObi":"IBR + OBI vs Clb+ OBI","phase3RCTmulti":"Phase 3, RCT, multi-centre, open label","ptsAged65orComor":"Pts aged ≥65 years or < 65 years with comorbidities*","cirs6":"*CIRS > 6, CrCl< 70 mL/min, and/or","deltp53":"del(17p)/TP53","mut":"mut","nr":" NR vs 19.0 mos (HR 0.23; 95% CI 0.15-0.37;","<0.01":"<0.001)","est30m":"Est. 30-mos PFS:","79%vs31%":"79% vs 31%","pfsInHighRisk":"PFS in high-risk patients: ","nrVS14":"NR vs 14.7 mos (HR 0.15; 95% CI 0.09-0.27; ","osRate30":"OS rate at 30 mos:","86vs85":"86%vs 85%","mostCommonGrade":"Most common grade 3/4 AEs:","neutrop":"Neutropenia & thrombocytopenia","saes58":"SAEs: 58% vs 35%","trd":"Treatment-related deaths: ","1bothArms":"1% in both arms","ecog":"ECOG-ACRIN E1912","ibr":"IBR + RTX vs FCR","phase3RCTopen":"Phase 3, RCT, multi-centre, open label","ptsAged70":"Pts aged ≤ 70 years","stratified":"Stratified according to age, ECOG-PS, Rai stage and","del11q23":"del11q23","presenceabsence":"presence/absence","exclusions":"Exclusions: Pts with","del(17)p":"del(17p)","pfsAt3yrs":"PFS at 3-yrs:","89vs73":" 89% vs 73% ","hr035":"(HR 0.35; 95% CI 0.22-0.56;","os3ys":"OS at 3-yrs:","99vs92":"99% vs. 92%","hr017":"(HR 0.17; 95% CI 0.05-0.54;","grade3AEs":"Grade ≥3 AEs:","80%bothArms":"80% in both arms","11vs20":"11% vs 20% (","ven":"Venetoclax","plusobinu":"(+ obinutuzumab)","cll14":"CLL14","5ysFollowUp":"5-Yr Follow-up","vene":"VENE + OBIN vs Clb+ OBIN","phase3MultiCenter":"Phase 3, multi-centre,","openlabel":"open label","ptsWithUntreated":"Pts with previously untreated CLL and coexisting medical conditions (CIRS > 6 and/or CrCl< 70 mL/min)","estPFS5ys":"Est. PFS at 5 years:","62vs27":" 62.6% vs 27.0% (HR0.35; 95% CI 0.26-0.46,","<0.0":"<0.0001)","estOS5ys":"Est. OS at 5 years:","88vs77":"88.9% vs 77.0% (HR 0.72; 0.48-1.09,","=0.12":"=0.12)","mostFrGrade":"Most frequent grade 3/4 AE:","neutropeniaVEN":"Neutropenia (52% [VENE + OBIN] vs 47% [Clb+ OBIN])","patientsWithAtLeast1":"Number of patients with at least 1 SPM:","21VenVS15":"21% (VENE + OBIN) vs 15% (Clb+ OBIN) = NS","all-case":"All-cause mortality:","9%vene":"9% (VENE+ OBIN) vs. 8%","clbObin":"(Clb+ OBIN) = NS","acala":"A = acalabrutinib;","acalal":"ACAL = acalabrutinib;","ben":"BEN = bendamustine;","br":"BR = bendamustine + rituximab;","celsius":"C = celsius;","ci":"CI = confidence interval;","cirs-g":"CIRS-G = Cumulative Illness Rating Scale –Geriatric;","clb":"Clb = chlorambucil;","cll":"CLL = chronic lymphocytic leukemia;","CrCL":"CrCl = creatinine clearance;","delpdef":"del(17p) = deletion 17p;","cgdef":"COG = Eastern Cooperative Oncology Group scale;","estdef":"est = estimated;","F":"F = fahrenheit;","HR":"HR = hazard ratio;","word":"IBR = ibrutinib;","mosdef":"mos = months;","NEdef":"NE = not estimated;","nrdef":"NR = not reached;","obinu":"O = obinutuzumab;","obinubi":"OBI = obinutuzumab;","osdef":"OS = overall survival;","pfsdef":"PFS = progression-free survival;","ptsdef":"Pts = patients;","rtxdef":"RTX = rituximab;","spmdef":"SPM = second primary malignancy;","venedef":"VENE = venetoclax;","ydef":"y = year;","yrdef":"Yr = year. 1. Sharman JP, et al. American Society of Clinical Oncology (ASCO) Annual","ref1":"Meeting; June 2-6, 2021. Poster #7539. 2. Barr PM, et al. American Society of","ref2":"Clinical Oncology (ASCO) Annual Meeting; June 4-8, 2021 (ASCO Virtual Meeting).","ref3":"Poster# 7523. 3. Woyach JA, et al.","engl":"N Engl J Med","ref4":". 2018;379(26):2517-2528. 4. Moreno C, et al.","oncol":"The Lancet Oncol","ref5":". 2019;20(1):P43-P56. 5. Shanafelt TD, et al.","ref6":". 2019;381:432-443. 6. Fischer K, et al.","ref7":". 2019;380:2225-2236."},"trialSummariesCont":{"glow4yr":"GLOW 4-Yr Follow-up","estPFS42":"Est. PFS at 42 mos:","ptsAged65":"Pts aged ≥65 years or 18-64 years with CrCl< 70 mL or CIRS >6","ptsAged65Comor":"Pts aged ≥65 years or 18-64 years with comorbidities and CrCl< 70 mL or CIRS >6","nrvi":"NR (V + I) vs 21.0 mos (O + Clb) (","nrz":"NR (Z) vs 28.1 mos (B + R) (","p":"P","75vi":"75% (V + I) vs 25% (O + Clb)","<001":"<0.001)","<0001":"<0.0001)","estPFS24":"Est. PFS at 24 mos:","85zbr":"85.5% (Z) vs 69.5% (B + R)","estOS42":"Estimated OS at 42 mos:","osVI88":"88% (V + I) vs 78% (O + Clb)","estOS24":"Estimated OS at 24 mos:","94zvs94br":"94.3 (Z) vs 94.6% (B+R)","grad34ae":"Grade 3/4 AEs:","neutropenia11z":"Neutropenia (11% [Z] vs 51% [B + R])","hypertension":"Hypertension (6% [Z] vs 5% [B + R])","cardiac":"All cardiac AEs (4% [Z]","vs4":"vs 4% [B + R])","aeDeath":"AE leading to death:","neutropenia34":"Neutropenia (34.9% [V + I] vs 49.5% [O + Clb])","infections15":"Infections (15.1% [V + I] vs 10.5% [O + Clb])","hyper75":"Hypertension (7.5% [V + I] vs 1.9% [O + Clb])","atrial6":"Atrial fibrillation (6.6% [V + I] vs 0% [O + Clb])","11inZ":"11 in Z arm and 12 in B + R arm","relatedDeaths":"Treatment-related deaths:","moreDeaths":"more deaths during","randomizedTreatment":"randomized treatment in","viArms":"V + I arm vs O + Clb arm","note":"Note: Cross-comparisons between treatment studies should not be inferred.","ae":" AE, adverse event;","bben":" B/BEN, bendamustine;","clb":" Clb, chlorambucil;","cirs":" CIRS, Cumulative Illness","rating":" Rating scale CrCl = creatinine clearance; ","iibr":" I/IBR, ibrutinib; ","mo":" mo = month; ","nr":" NR, not reached; ","oobin":" O/OBIN = obinutuzumab; ","os":" OS, overall survival; ","pfs":" PFS, progression-free survival;","pt":" Pt, patient; ","rrtx":" R/RTX, rituximab; ","vven":" V/VEN = venetoclax; ","yr":" Yr = year; ","zan":"Z/ZAN, zanubrutinib.","ref1":"1. Niemann C, et al. ASH Annual Meeting; December 10-13, 2022; Abstract #93. 2. Tam C, et al.","oncol":"Lancet Oncol.","ref2":"2022;23(8):P1031-1043."},"summary":{"title":"Patient Resources (Saved Pages)","email":"Email","print":"Print","printNote":{"bold":"When printing:","text":"Please note that only the content currently displayed on the screen below will print. Ensure your preferred content is selected before printing."},"scan":"Scan QR code for saved summary pages","encouraged":"You are encouraged to share these resources with your caregivers","ifyoudlike":"If you would like to include all of the content for a particular agent, please select your agent(s) of interest below:"},"references":{"title":"References","cancerCare":" Cancer Care Alberta. Clinical Practice Guideline LYHE-007 –Version 7. www.ahs.ca/guru. Accessed December 18, 2021.","options":"StefaniukP, et al. Therapeutic Options for Patients with TP53 Deficient Chronic Lymphocytic Leukemia: Narrative Review.","cancerMgmt":"Cancer Management and Research","cancerMgmtCont":". 2021;13;1459-1476.","hallekM":"HallekM, et al. iwCLLguidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL.","blood":"Blood","hallekMCont":". 2018;131(25):2745-2760.","azPM":" AstraZeneca Canada Inc. Calquence (Acalabrutinib) Product Monograph.","azPMLink":"https://www.astrazeneca.ca/content/dam/az-ca/downloads/productinformation/calquence-product-monograph-en.pdf.","azPMassessed":" Accessed January 4, 2022.","byrd":"Byrd JC, et al. Acalabrutinib Versus Ibrutinib in Previously Treated Chronic Lymphocytic Leukemia: Results of the First Randomized Phase III Trial.","jclinoncol":"J Clin Oncol","byrdCont":". 2021;39(31):3441-3452.","coiffer":"Coiffer B, et al. Guidelines for the Management of Pediatric and Adult Tumor Lysis Syndrome: An Evidence-Based Review.","coifferCont":". 2008;26(16):2767-2778.","owenC":"Owen C, et al. Canadian evidence-based guideline for the first-line treatment of chronic lymphocytic leukemia.","currOncol":"CurrOncol","owenCcont":". 2018;25(5):e461-e474.","roche":" Roche Canada. Gazyva (Obinutuzumab) Product Monograph. https://www.rochecanada.com/PMs/Gazyva/Gazyva_PM_E.pdf. Accessed January 28, 2022.","sharman":"Sharman JP, et al. Acalabrutinib with or without obinutuzumab versus chlorambucil and obinutuzmab for treatment-naive chronic lymphocytic leukaemia (ELEVATE TN): a randomised, controlled, phase 3 trial.","lancet":"Lancet","sharmanCont":". 2020;395(10232):1278-1291.","janssen":" Janssen Inc. Imbruvica (Ibrutinib) Product Monograph. https://pdf.hres.ca/dpd_pm/00046525.PDF. Accessed January 28, 2022.","abbVie":" AbbVie Corporation. Venclexta (Venetoclax) Product Monograph. https://www.abbvie.ca/content/dam/abbvie-dotcom/ca/en/documents/products/VENCLEXTA_PM_EN.pdf. Accessed January 29, 2022.","alsawaf":"Al-Sawaf O, et al. Venetoclax plus obinutuzumab versus chlorambucil plus obinutuzumab for previously untreated chronic lymphocytic leukaemia (CLL14): follow-up results from a multicentre, open-label, randomised, phase 3 trial.","lancetOncol":"Lancet Oncol","alsawafCont":". 2020;21(9):1188-1200.","cancerCareOnt":" Cancer Care Ontario. FC+R Regimen. August 2020. https://www.cancercareontario.ca/sites/ccocancercare/files/FCR_HEM_CLL.pdf. Accessed February1, 2022","shadmanM":"Shadman M, et al. Debate: What Is Optimal First-Line Therapy for Chronic Lymphocytic Leukemia?","JNCCN":"JNCCN","shadmanCont":".2020;18(7.5):994-997. doi: 10.6004/jnccn.2020.5011."},"referencesCont":{"sharman":"Sharman JP, et al. Efficacy and safety in a 4-year follow-up of the ELEVATE-TN study comparing acalabrutinib with or without obinutuzumab versus obinutuzumab plus chlorambucil in treatment-naïve chronic lymphocytic leukemia.","leukemia":"Leukemia","sharmanCont":". 2022;36(4):1171-1175.","barrPM":"Barr PM, et al. Up to 8 Years Follow-up From RESONATE-2: First-Line Ibrutinib Treatment for Patients With Chronic Lymphocytic Leukemia.","bloodAdv":"Blood Adv","barrPMCont":". doi:10.1182/bloodadvances.2021006434.","alSawaf":"Al-Sawaf O, et al. Minimal Residual Disease Dynamics after Venetoclax-Obinutuzumab Treatment: Extended Off-Treatment Follow-up From the Randomized CLL14 Study.","jclinoncol":"J Clin Oncol","alSawafCont":". 2021;39(36):4049-4060.","alSawafVen":" Al-Sawaf O, et al. Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 4-year follow-up analysis of the randomized CLL14study. Presented at the European Hematology Association (EHA) Annual Meeting; June 11, 2021.","fisherK":" Fischer K, et al. Long-term remissions after FCR chemoimmunotherapy in previously untreated patients with CLL: updated results of the CLL8 trial. Blood. 2016;127(2):208-221.","zenT":"Zenz T, et al. TP53 mutation and survival in chronic lymphocytic leukemia.","zanTCont":". 2010;28(29):4473-4479.","cancerCareOntAcala":"Cancer Care Ontario. Acalabrutinib –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/63766. Accessed March 15, 2022.","cancerCareOntObinu":"Cancer Care Ontario. Obinutuzumab –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44386. Accessed March 15, 2022.","cancerCareIbru":" Cancer Care Ontario. Ibrutinib –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44366. Accessed March 15, 2022.","cancerCareVen":" Cancer Care Ontario. Venetoclax –Patient Info Sheet. https://www.cancercareontario.ca/en/drugformulary/drugs/infosheet/44476.Accessed March 15, 2022.","cancerCareFC":" Cancer Care Ontario. FC Regimen. https://www.cancercareontario.ca/en/system/files_force/FC_HEM_CLL.pdf?download=1. Accessed March 16, 2022.","rochePM":" Roche Canada. Rituxan (Rituximab) Product Monograph. https://www.rochecanada.com/PMs/Rituxan/RituxanIV_PM_E.pdf. Accessed March 16, 2022.","kotiah":"Kotiah SD, et al. Chronic Lymphocytic Leukemia Treatment Protocols.","drugs":"Drugs & Diseases","kotiahLink":" . https://emedicine.medscape.com/article/2005390-overview. Accessed February 8, 2022.","cancerCareIbruReg":"Cancer Care Ontario. IBRU Regimen. https://www.cancercareontario.ca/sites/ccocancercare/files/IBRU_HEM_CLL.pdf . Accessed February 8, 2022."},"referencesCont1":{"fischer":"Fischer K, et al. Venetoclaxand Obinutuzumab in Patients with CLL and Coexisting Conditions.","englj":"N Engl J Med","fischerCont":". 2019;380:2225-2236.","cancerVeneObin":" Cancer Care Ontario. VENE+OBIN Drug Formulary. https://www.cancercareontario.ca/en/drugformulary/regimens/monograph/62876. Accessed February 7, 2022.","cdhta":" Canada’s Drug and Health Technology Agency. https://www.cadth.ca/reimbursement-review-reports. Accessed April 20, 2022.","lymphoma":"Lymphoma Canada. Frontline Therapy Provincial Drug Funding -Chronic Lymphocytic Leukemia (CLL) & Small Lymphocytic Lymphoma (SLL). https://www.lymphoma.ca/wp-content/uploads/2020/12/CLL-SLL-Provincial-Drug-Funding-Table.pdf. Accessed April 20, 2022.","canada":" Government of Canada. https://www.canada.ca/en/indigenous-services-canada/search/advanced-search.html. Accessed April 20, 2022","barrPM":" Barr PM, et al. Acalabrutinib±obinutuzumabversus obinutuzumab+chlorambucilintreatment-naïve chronic lymphocytic leukemia: Elevate-TN four-year follow-up. American Society of Clinical Oncology (ASCO) Annual Meeting; June 4-8, 2021 (ASCO Virtual Meeting). Poster# 7523.","woyach":"Woyach JA, et al. Ibrutinib Regimens versus Chemoimmunotherapy in Older Patients with Untreated CLL.","woyachCont":". 2018;379(26):2517-2528.","morenoC":"Moreno C, et al. Ibrutinib plus obinutuzumabversus chlorambucil plus obinutuzumabin first-line treatment of chronic lymphocytic leukaemia (iLLUMINATE): a multicentre, randomised, open-label, phase 3 trial.","lancetOncol":"The Lancet Oncology","morecoCont":". 2019;20(1):P43-P56.","shanafelt":"Shanafelt TD, et al. Ibrutinib–Rituximab or Chemoimmunotherapy for Chronic Lymphocytic Leukemia.","shanafeltCont":". 2019;381:432-443."}}}],["$","$L12",null,{"src":"https://policy.cookiereports.com/99e5bfa3_panel-en-gb.js"}]]}]}]