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• This is a place to practice clicking the "edit" button and practice adding references (via the citation button).

Task:

1. Find a peer-reviewed journal article on PubMed. Practice inserting your citation in the above space using the "cite" tool
2. Choose one "B-level" medical article on Wikipedia from the following list: https://wp1.openzim.org/#/project/Medicine/articles?quality=B-Class&importance=High-Class
3. Practice editing live on Wikipedia by finding a typo in the text or improving the clarity/readability of a sentence by adjusting a few words in a sentence.

1.      Proposed Changes

Original: In those with significant symptoms, chemotherapy or immunotherapy may be used.[4] As of 2019 ibrutinib is often the initial medication recommended.[11] The medications fludarabine, cyclophosphamide, and rituximab were previously the initial treatment in those who are otherwise healthy.[12]

Proposed Changes: In those with significant symptoms or active disease, chemotherapy, immunotherapy, or chemoimmunotherapy may be used.[4] Depending on the individual’s age, physical condition, and whether they have the del(17p) or TP53 mutation, different first line treatments may be offered.[83] As of 2021, BTK inhibitors such as ibrutinib and acalabrutinib are often recommended for first line treatment of CLL.[84] The medications fludarabine, cyclophosphamide, and rituximab were previously the initial treatment in those who are otherwise healthy.[12]

2.     Rationale for Proposed Changes

Original: In those with significant symptoms, chemotherapy or immunotherapy may be used.[4]

Revision: In those with significant symptoms or active disease, chemotherapy, immunotherapy, or chemoimmunotherapy may be used.[4]

• The referenced source states that significant symptoms as well as symptoms indicative of active disease may necessitate treatment, as highlighted in this passage: “Generally, indications to initiate therapy include pronounced disease-related anaemia or thrombocytopenia (patients with Rai stage III or stage IV disease, or Binet stage C disease), symptomatic lymphadenopathy and/or symptoms that are associated with active disease...”.
• Per the referenced source, in most cases, chemoimmunotherapy (e.g. the combination of chemotherapy and immunotherapy) is indicated, rather than the use of one or the other. I believe adding ‘or chemoimmunotherapy’ adds clarity and accuracy to this sentence.
• Added wikilink for chemoimmunotherapy.

Added sentence: Depending on the individual’s age, physical condition, and whether they have the del(17p) or TP53 mutation, different first line treatments may be offered.[83]

• The original passage made it seem that ibrutinib was the first line treatment for all individuals with CLL. There was no mention of the fact that age, physical condition, and the presence of certain mutation necessitate different first line treatment options, as was highlighted in my article. This sentence clarifies this point.
• Added wikilinks for del(17p) and TP53.

Original: As of 2019 ibrutinib is often the initial medication recommended.[11]

Revision: As of 2021, BTK inhibitors such as ibrutinib and acalabrutinib are often recommended for first line treatment of CLL.[84]

• Updated the date to 2021 per updated source (Patel & Pagel, 2021).
• Added more specificity to the type of drug that is recommended as first line treatment (aka BTK inhibitors).
• Added the two BTK inhibitors that are currently approved for treatment of CLL as mentioned in updated source (Patel & Pagel, 2021).
• Added a wikilink for acalabrutinib and BTK inhibitors.

3.     Area of Controversy

Not applicable to my proposed changes.

4.     Critique of Source

83: Hallek, M. (2019). Chronic lymphocytic leukemia: 2020 update on diagnosis, risk stratification and treatment. American Journal of Hematology, 94(11), 1266–1287. https://doi.org/10.1002/ajh.25595

• As stated in the article itself, the management of CLL is rapidly changing and though this article was published in 2020, recommendations are updated on a bi-annual basis and thus may already be out of date.
• Many of the newer drugs discussed in the article (including BTK inhibitors) are still undergoing clinical trials for both monotherapy and different combined therapies, so information published here may be preliminary and subject to change. As well, long-term effects of many of these novel drugs may change recommendations over time.

84: Patel, K., Pagel, J.M. Current and future treatment strategies in chronic lymphocytic leukemia. J Hematol Oncol 14, 69 (2021). https://doi.org/10.1186/s13045-021-01054-w

• The same critiques mentioned for the previous article apply to this article as well.
• This article specifically mentions that more research is needed to determine optimal treatment courses as well as to assess the efficacy and safety of combination therapies, so the recommendations provided are subject to change.

• This will also be covered on Nov 15th in class. Your group should use the below template to share an outline of your proposed improvements (including your new wording and citations). Article talk pages are not places to share your assignment answers. The Wikipedia community will be more interested in viewing your exact article improvement suggestions including where you plan to improve the article (which section), what wording you suggest, and the exact citation (Note: all citations must meet WP:MEDRS)
• You will not be able to paste citations directly from your sandbox to talk pages (unless you are interested in editing/learning Wiki-code in the "source editing" mode). We suggest re-adding your citations on the talk page manually (using the cite button and populating the citation by pasting in the DOI, website, or PMID). You will have to repeat this process yet again when you edit the actual article live.
• Talk Page Template: Wikipedia:CARL Medical Editing Initiative/Fall 2021/Talk Page Template