The Daily Burden of BTK Inhibitor Therapy: Kerry Rogers, MD

In the clinical management of chronic lymphocytic leukemia (CLL), the adverse effects that command the most attention are not always the ones that matter most to patients. Cardiac arrhythmias and hypertension are closely monitored, and treatment algorithms are adjusted accordingly. Yet, for many patients on Bruton tyrosine kinase (BTK) inhibitor therapy, the daily accumulation of lesser-discussed toxicities quietly determines whether treatment remains sustainable.

Kerry Rogers, MD, hematologist, CLL specialist, and associate professor at The James/The Ohio State University Comprehensive Cancer Center, has long focused on the therapeutic use of BTK inhibitors. She has developed a particular focus on the gap between what physicians identify as medically significant and what patients experience as most burdensome, a distinction that has important implications for treatment adherence, patient satisfaction, and long-term outcomes.

Rogers has directed considerable attention toward 3 toxicities she considers systematically underemphasized in clinical practice. The first is musculoskeletal pain, the arthralgias and myalgias that affect patients on a daily basis, often beginning with the morning hours and persisting throughout the day. The second is gastrointestinal disruption, which can meaningfully restrict a patient’s activities and diminish their quality of life. The third is bruising, specifically, the extensor surface bruising that disproportionately affects older patients on these agents. Although medically benign in most cases, this bruising carries a cosmetic and psychosocial burden that clinical teams frequently underestimate. As Rogers has observed in her own practice, patients alter their clothing, avoid social situations, and carry a quiet embarrassment that rarely surfaces in a standard clinic visit unless a physician specifically creates space for it. She noted, “We don’t discuss that enough in our clinics because it’s a cosmetic problem.” She has made it her work to change that.

Where evidence is limited, she says so. Where patients themselves have identified what works, whether that is dietary adjustments, supplementation, or modified dosing schedules, she treats that knowledge as clinically meaningful and shares it across her patient population. It is a model of practice grounded equally in scientific rigor and genuine attentiveness to the patient experience.

In this interview segment, Rogers addresses the practical management of BTK inhibitor tolerability in CLL, with particular attention to the toxicities most frequently underdiscussed in routine care. She speaks to what the current evidence supports, where clinical judgment must fill the gaps, and how providers can structure conversations with patients to better capture the full burden of treatment.