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Articles

Alopecia profoundly disrupts identity, emotional wellbeing, and social life, with many people struggling due to stigma, concealment pressures, and unmet psychological support needs.

Exploring Identity, Appearance Experiences Among Patients With Alopecia

Oral semaglutide (Wegovy; Novo Nordisk) expands GLP-1 weight-loss options, but pharmacy budgets and health care cost pressures persist.

5 Things to Know About the Oral GLP-1 Era

Mary Caffrey is the Executive Editor for The American Journal of Managed Care® (

®). She joined AJMC® in 2013 and is the primary staff editor for 

the multistakeholder publication that reaches 22,000+ oncology providers, policy makers and formulary decision makers. She is also part of the team that oversees speaker recruitment and panel preparations for 

®'s premier annual oncology meeting, Patient-Centered Oncology Care®. For more than a decade, Mary has covered ASCO, ASH, ACC and other leading scientific meetings for 

Mary has a BA in communications and philosophy from Loyola University New Orleans. You can connect with Mary on 

A study from Sweden, the largest of its kind, challenges the standard 24-month milestone as the key point when early relapse is a concern.

Even After 6 Years, Disease Progression Impacts Survival in Mantle Cell Lymphoma

Study links elevated serum haptoglobin to chronic spontaneous urticaria activity, suggesting it predicts treatment response and complete disease control.

Potential Predictor of Treatment Response in Chronic Spontaneous Urticaria Identified

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Compendium

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

When imatinib (Gleevec; Novartis), the first-ever tyrosine kinase inhibitor, made its debut in chronic myelogenous leukemia (CML), it revolutionized the treatment of a disease with a once-dismal prognosis.

Prior to its 2001 approval, CML therapies were often harsh, invasive, and ineffective.

Now, 25 years later, current studies continue to align with previous research associating imatinib with major cytogenic responses,

 and targeted therapies have become cornerstones of treatment in a range of tumor types.

Imatinib was first used to treat patients during a clinical trial in 1998. Lead researchers in the earliest studies were Brian J. Druker, MD; Stephen G. O’Brien, MD; Jorge Cortes, MD; and Jerald Radich, MD. 

had the pleasure of speaking with Cortes, discussing the history and evolution of imatinib in the CML treatment paradigm.

Patients with CML, unlike patients with acute lymphoblastic leukemia, are likely to have a longer life expectancy with and without treatment. Those with CML can still have a life expectancy of 3 to 5 years after diagnosis without treatment, but with treatment, their life expectancy is closer to the national average.

“I still remember Dr. Talpaz coming out of rooms and saying, ‘Wow, this thing works.’ He had this expression of wonder at the big change that it was representing... When the new study started...patients came to the study, but they wanted to get imatinib,” Cortes said.

Development of imatinib began in the early 1990s under Druker at Oregon Health and Science University.

 Druker aimed to find a treatment for CML, and with the help of Nicholas Lyndon, MD, they identified a drug that was able to kill CML cells efficiently.

The phase 1 clinical trial of imatinib in 1998 was partially funded by the National Cancer Institute. The drug was then FDA-approved in 2001 to treat patients with CML. Of the patients in the original trial, 5 years later, 98% of them were still in remission.

“[But] we're not done [yet]. Patients are still looking for a better quality of life, for being able to stop therapy and all of that. We've made tremendous progress, and… we want to be optimistic, but we want to still always be careful and cautious and respect what cancer can do,” Cortes said.

Listen above or on one of these podcast services:

1. How Gleevec transformed leukemia treatment. National Cancer Institute. April 11, 2018. Accessed November 10, 2025. 

https://www.cancer.gov/research/progress/discovery/gleevec#:~:text=NCI-supported%20research%20led%20to,evidence%20to%20support%20this%20hypothesis

2. Druker BJ, O’Brien SG, Cortes J, Radich J; Chronic myelogenous leukemia. 

 2002 (1):111–135. doi:10.1182/asheducation-2002.1.111

3. Chronic myeloid leukemia (CML) research. Blood Cancer United. Accessed November 10, 2025. 

https://bloodcancerunited.org/research/blood-cancer-research-development-progress/leukemia/chronic-myeloid-leukemia-cml

4. Targeted therapy for cancer. National Cancer Institute. Updated May 31, 2022. Accessed November 11, 2025. 

https://www.cancer.gov/about-cancer/treatment/types/targeted-therapies

5. Faiman B. The impact of federal funding cuts on research, practice, and patient care. 

. 2025;16(4):124-125. doi:10.6004/jadpro.2025.16.4.1

Lead CML researcher discusses the evolution of a groundbreaking treatment and its effect on patient survival.

Inside the Discovery That Changed CML Treatment Forever: Jorge Cortes, MD

Among the latest data being presented at the 

American Society of Hematology Annual Meeting and Exposition

, held December 7-10, 2024, in San Diego, California, were 3 abstracts that focused on patient preferences and treatment choices.

Sikander Ailawadhi, MD, professor of medicine in the Division of Hematology/Oncology at the Mayo Clinic, Florida, was a coauthor on all 3 abstracts, covering patient preferences for Bruton tyrosine kinase inhibitors in chronic lymphocytic leukemia and small lymphocytic lymphoma, survivorship burden and patient preferences affecting treatment choices in multiple myeloma, and race/ethnicity-specific sociodemographic and economic factors driving refusal of treatment in multiple myeloma.

Listen above or through one of these podcast services:

Three abstracts presented at the 2024 American Society of Hematology annual meeting focused on patient preferences and treatment choices in blood cancers.

Diving Into Patient Preferences for Blood Cancer Treatments With Dr Sikander Ailawadhi

Real-world ONCare data show acalabrutinib lowers new-onset HTN, CV events, and discontinuations vs ibrutinib in R/R CLL/SLL.

Real-World Evidence Backs Acalabrutinib in CLL Care

This new study reveals venetoclax and rituximab effectively treat chronic lymphocytic leukemia, showing high response rates and prolonged progression-free survival.

CLL Breakthrough: 100% Efficacy Reported for VenR Retreatment

A review article focused on first-line treatment of chronic lymphocytic leukemia highlights the importance of shared decision-making. 

Novel CLL Therapies Prompt New Treatment Considerations

IGHV-unmutated CLL comprises 2 distinct epigenetic subtypes with different B-cell maturation signatures and genetic alterations, a study found.

Study Identifies 2 Distinct Epigenetic Subtypes Within Aggressive CLL

Richter transformation with CNS involvement in CLL presents a poor prognosis, highlighting the need for tailored treatment strategies and further research.

Limited Survival in CLL With CNS Richter Transformation

Dr Margaret Krackeler on Real-World Data in CLL

Real-world evidence has a growing role in guiding treatment decisions for 

 (CLL), Margaret Krackeler, MD, of Kaiser Permanente Northern California, explained in an interview with 

 evaluating outcomes with zanubrutinib across the Kaiser Permanente health system.


Krackeler emphasized the collaborative effort required to successfully transition patients to newer therapies. Pharmacy teams, providers, and patients worked closely together to ensure continuity of care while adopting evidence-based updates to the treatment algorithm. This experience demonstrated how integrated health systems can implement rapid practice changes when supported by robust data, Krackeler said.


She noted that real-world research plays a critical role in informing these decisions, particularly because it reflects outcomes that directly affect medication utilization, adherence, and treatment tolerability. Unlike clinical trials, which often include narrowly selected populations, real-world data capture how therapies perform in everyday practice—an especially important consideration for chronic diseases such as CLL that require long-term treatment. 

“I do hope that this study helps contribute to this field of real-world research that I think a lot of our oncology field is moving toward,” Krackeler said.


Addressing the broader value of real-world data, Krackeler pointed to the study’s scale as a key strength. At the time of publication, it was the largest real-world cohort of patients with CLL treated with zanubrutinib, encompassing 281 patients within Kaiser Permanente Northern California. Although she acknowledged the significance of this sample size, she also stressed the potential impact of even larger datasets in further clarifying the tolerability and effectiveness of newer therapies outside controlled trial settings.


Krackeler noted that real-world evidence is becoming increasingly central to oncology practice, helping clinicians and health systems better understand how emerging treatments translate into real patient outcomes and informing evidence-based, value-driven care decisions that lead to the best possible outcomes for patients.

Krackeler ML, Chee BH, Orchanian AK, et al. Real-world treatment patterns and outcomes of zanubrutinib in chronic lymphocytic leukemia and small lymphocytic leukemia (CLL/SLL). 

Published online October 25, 2025. doi:10.1002/cam4.71300

Videos

Margaret Krackeler, MD, of Kaiser Permanente Northern California, discusses the growing role of real-world treatment data in CLL and other cancers.

Health System

The Value of Real-World Data in CLL: Margaret Krackeler, MD

Real-World Data Support Zanubrutinib Use in Older Patients With CLL: Margaret Krackeler, MD

Margaret Krackeler, MD, of Kaiser Permanente in Northern California, discussed real-world findings from a study evaluating zanubrutinib treatment patterns and outcomes in patients with 

 (CLL), with particular focus on tolerability, cardiac safety, and outcomes in higher-risk populations. The study, published in 

, adds to a growing body of evidence suggesting that second-generation Bruton tyrosine kinase (BTK) inhibitors may offer important safety advantages over earlier agents while maintaining clinical effectiveness.

Krackeler explained that although overall adverse event (AE) rates with zanubrutinib were similar to those seen with other BTK inhibitors, the drug was associated with fewer treatment-limiting toxicities and lower rates of cardiac events—an especially meaningful finding for older patients and those with preexisting cardiovascular risk. In the cohort, approximately one-quarter of patients had baseline cardiac comorbidities, and nearly 40% were receiving anticoagulation or antiplatelet therapy prior to starting BTK inhibitor treatment. Despite this elevated risk profile, patients demonstrated strong tolerability and relatively low rates of cardiac AEs.

“This is especially relevant because we want to ensure that they are able to tolerate the medication long term so that they continue to have good disease control, even as their risk increases with age and additionally with cardiac comorbidities,” Krackeler said.

The study also offered encouraging signals among patients considered higher risk, with most remaining on zanubrutinib at the end of follow-up. However, Krackeler noted that the cohort was small, and cytogenetic data—critical for fully assessing risk—were incomplete for many patients, reflecting a common limitation of real-world studies.

While emerging evidence supports BTK inhibitor use in high-risk populations, she stressed that larger studies with more comprehensive molecular data are needed to better define outcomes in this group. Together, the findings underscore both the promise of zanubrutinib in routine practice and the ongoing need for robust real-world research to guide individualized CLL treatment decisions.

Margaret Krackeler, MD, discusses real-world data supporting the switch from ibrutinib to zanubrutinib for chronic lymphocytic leukemia. 

Practice-Level Perspectives on Zanubrutinib Adoption for CLL Treatment: Margaret Krackeler, MD

Margaret Krackeler, MD, hematologist/oncologist at Kaiser Permanente in Northern California, discusses how the practice has evolved its 

 (CLL) treatment algorithm, particularly the transition from ibrutinib to zanubrutinib among patients receiving Bruton tyrosine kinase (BTK) inhibitor therapy. The conversation highlights how emerging evidence is translating into everyday oncology practice.

This transcript has been lightly edited for clarity.

systemwide transition from ibrutinib to zanubrutinib

 in a real-world community oncology setting. What outcomes most strongly validated this practice change once it was implemented at scale?

In a real-world practice change from ibrutinib to zanubrutinib at Kaiser Permanente in Northern California, I would say the most compelling outcomes that validated the switch were the improved tolerability and persistence with zanubrutinib as compared to ibrutinib. In our study, patients switching to zanubrutinib had fewer treatment-limiting adverse events, as well as cardiac adverse events, and most of them, 79% of these patients, did remain on zanubrutinib at the last follow-up, without any treatment-related deaths. I would say that these outcomes, supported by our real-world data, really suggest that the switch led to better real-world safety and effective use of zanubrutinib after this practice change at Kaiser Permanente in Northern California.


Most patients who switched from ibrutinib, including some who previously progressed, remained on zanubrutinib. What does this tell us about BTK inhibitor sequencing in everyday practice?

Most of our patients who switched from ibrutinib remained on zanubrutinib. As I stated earlier, 79% of the patients remained at the end of our follow-up, and we did see good tolerability on that medication. Looking at the patients who specifically had adverse events on ibrutinib, 17% of those patients ended up having a recurrence of those adverse events while on zanubrutinib, but there were low rates of treatment discontinuation of zanubrutinib with those adverse events. 

I do think that our real-world data support the use of switching to a different BTK inhibitor like zanubrutinib if the first generation or a different BTK inhibitor is not tolerated. There was a small cohort of patients where we found that they were switched to zanubrutinib due to progression on ibrutinib, and that was done at the discretion of the treating provider. However, a lot more research is needed to see if that is a standard practice or something that should be adopted. More information is really needed to see if that is effective. Our small population of patients were still on zanabrutinib, even after progression of ibrutinib, but there's really not enough data to really comment on if that sequencing is appropriate for that indication.

Adopting zanubrutinib for the treatment of chronic lymphocytic leukemia showed improved tolerability and persistence, enhancing patient safety and outcomes.

Perspectives on Zanubrutinib Adoption for CLL Treatment: Margaret Krackeler, MD

Dr David Kuter, immune thrombocytopenia, ITP, rilzabrutinib, FDA approval, autoimmune

Rilzabrutinib Offers a New, Well-Tolerated Option for Patients With ITP: David Kuter, MD, DPhil

 rilzabrutinib (Wayril; Sanofi) as a first-in-class treatment for patients with 

 (ITP), a rare autoimmune disorder. The approval was supported by results from the phase 3 LUNA 3 study (

), which evaluated the efficacy and safety of rilzabrutinib vs placebo in adults and adolescents with persistent or chronic ITP.

David Kuter, MD, DPhil, the lead investigator of the LUNA 3 study, shares what distinguishes rilzabrutinib, the first Bruton tyrosine kinase (BTK) inhibitor approved for ITP, from existing treatments. He also compares its safety profile with that of other ITP therapies.

 to learn what rilzabrutinib's approval means for patients with ITP and the challenges clinicians may face when incorporating this treatment into routine clinical practice.

This transcript has been lightly edited; captions were auto-generated.

Rilzabrutinib is the first Bruton BTK inhibitor approved for ITP. How does its mechanism of action differ from other treatments currently available for ITP?

Other treatments for ITP include things like, 100 years ago, taking your spleen out. We still do that in some places; it is an effective therapy, but it has side effects to it, which most patients and doctors reject. The other current therapy is a thrombopoietin receptor agonist, which is a medication that makes you make more platelets and gives you good response rates in many patients. 

The third is to use an older immunosuppressive drug called rituximab, which decreases your immune system, and it has a response rate of about 57% in patients who receive it. Finally, there is a newer medication called fostamatinib, which inhibits a different pathway, called the SYK [spleen tyrosine kinase] pathway, which has a response rate of some 18% but brings with it side effects of usually diarrhea and hypertension, which many patients find disconcerting. Those are the standard therapies. Some are quite effective. They all come with their own negatives. 

Rilzabrutinib (Wayrilz; Sanofi), a BTK inhibitor, targets immune-mediated platelet destruction in immune thrombocytopenia (ITP) and has demonstrated a favorable safety profile.

Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

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