Management of Chronic Lymphocytic Leukemia in Elderly Patients

Abstract

Chronic lymphocytic leukemia (CLL) is most commonly diagnosed in patients older than 65 years. Although CLL is commonly believed to be indolent in elderly patients, several studies have shown that CLL reduces life expectancy. In elderly patients who need treatment for CLL, evaluation of disease-specific risk factors should be accompanied by measurement of fitness status and co-morbidities so that a treatment option can be selected that best fits the individual patient's goals of therapy. To help define such treatments, a number of recently conducted clinical trials have included elderly or unfit patients. Although purine analog-containing regimens are still recommended for elderly patients who are fit, new approaches are rapidly expanding the treatment options for elderly and unfit individuals. KEYWORDS• B-cell receptor targeted therapy • chronic lymphocytic leukemia • CIRS • cumulative illness rating scale • elderly • lenalidomide • monoclonal antibody Practice points• Elderly and unfit patients have been often excluded from clinical trials.• We need to consider whether 'how old are you?' is the correct question? Should physiological age be preferred over chronological age when considering treatment options in the elderly with chronic lymphocytic leukemia (CLL)?• In considering the best treatment option for an elderly patient with CLL, the most important question to be answered is whether the patient is fit, unfit or frail.• The inclusion of monoclonal antibody has been proven to improve the efficacy of chemotherapy-based regimen without adding excessive toxicity in elderly and unfit patients.• The need to combine sufficient efficacy with optimal safety profiles in elderly patients supports the prompt evaluation of these agents in the elderly.• Ongoing Phase II/III studies are recruiting patients to further assess the antileukemic activity and tolerability, alone or in combination, of monoclonal antibodies, lenalidomide, ibrutinib, idelalisib and new emerging compounds.• Treatment of CLL in elderly patients is a compelling challenge because patients older than 70 years comprise the vast majority of the people living with CLL.