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Management of unfit elderly patients with chronic lymphocytic leukemia

  • Barbara Eichhorst
    Correspondence
    Corresponding author at: German CLL Study Group, Dept. I of Internal Medicine, University Hospital Cologne, 50924 Cologne, Germany.
    Affiliations
    German CLL Study Group (GCLLSG), Dept. I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany
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  • Michael Hallek
    Affiliations
    German CLL Study Group (GCLLSG), Dept. I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany

    Excellence Cluster Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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  • Valentin Goede
    Affiliations
    German CLL Study Group (GCLLSG), Dept. I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany

    Oncogeriatric Unit, Dept. of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
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      Abstract

      Chronic lymphocytic leukemia (CLL) is a disease characterized by an increasing incidence with age reaching 35/100,000 in patients over 85 years. Elderly CLL patients carry several challenges, which have to be considered particularly in advanced stages including a higher risk of infections and individual differences in comorbidities and geriatric syndromes. Although no specific tool for geriatric evaluation in CLL has been developed so far, several of them (e.g. CIRS or Charlson-Score) have been tested in CLL patients. Several treatment options exist for frontline and relapse therapy in unfit CLL patients. Less intensive chemoimmunotherapy with engineered CD20 antibodies (e.g. obinutuzumab) is one of the treatment options, if TP53 mutation or deletion has been ruled out by genetic testing. Single agent treatment with the Btk-inhibitor ibrutinib is not only approved in relapsed CLL; but also for frontline therapy. The kinase inhibitor idelalisib (plus rituximab) and the bcl2 inhibitor venetoclax are other novel compounds, which showed great efficacy in relapsed CLL even in unfit patients. Treatment decisions in unfit patients have to take patient-related as well as disease-related risk factors into consideration.

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