Uniting CLL and Lymphoma Care: Adam S. Kittai, MD

The treatment landscape for chronic lymphocytic leukemia (CLL) and lymphoma continues to evolve, with increasing overlap between the 2 disease areas, according to Adam S. Kittai, MD, director of the CLL Program, Perlmutter Cancer Center; director of the Lymphoma Program Perlmutter Cancer Center–Long Island; and associate professor at NYU Grossman School of Medicine.

Although CLL and lymphoma have traditionally been managed under different disease umbrellas at some institutions, Kittai noted that the diseases share substantial similarities. At NYU, CLL and lymphoma are approached as closely related diseases, with Kittai overseeing CLL care across the health system and helping coordinate clinical trials for patients on Long Island and in Manhattan and Brooklyn. He also leads lymphoma care across Perlmutter Cancer Center’s Long Island sites, working closely with colleagues in Manhattan to identify clinical trials suited to the needs of local patient populations.

One example of the close relationship between CLL and lymphoma is small lymphocytic lymphoma (SLL), which accounts for approximately 10% of patients who present with lymph node–only disease. Kittai described SLL and CLL as essentially the same disease along a continuum, with the same treatment approach and prognosis.

The overlap also extends to treatment. Drugs that form the backbone of CLL therapy, including Bruton tyrosine kinase inhibitors and anti-CD20 monoclonal antibodies, are also used across lymphoma subtypes. Kittai pointed to zanubrutinib as one example, noting its use in CLL as well as mantle cell lymphoma and lymphoplasmacytic lymphoma. Meanwhile, newer approaches developed in lymphoma are increasingly entering the CLL treatment landscape, including chimeric antigen receptor (CAR) T-cell therapy and investigational bispecific antibodies.

For Kittai, perhaps the most significant development is the emergence of therapies that can overcome traditional prognostic factors and treatment resistance. T-cell–redirecting approaches, including CAR T-cell therapy and bispecific antibodies, have demonstrated activity even in patients whose disease is resistant to chemotherapy. Rather than relying on chemotherapy, these therapies engage T cells to attack malignant cells, potentially overcoming factors that previously predicted poor outcomes.

“It’s exciting that we now have therapies that work despite our classic prognostic features,” he said, “and also have therapies that work when patients are chemoresistant and relapse on our original frontline therapy.”

Importantly, Kittai noted that disease bulk, rather than several classic prognostic features, appears to be a major predictor of outcomes with CAR T-cell therapy in both CLL and lymphoma. The result is a rapidly expanding therapeutic landscape, offering new options for patients with relapsed or treatment-resistant disease.