Onkologie. 2017:11(3):108-114 | DOI: 10.36290/xon.2017.022

Treatment of elderly and comorbid patients with chronic lymphocytic leukemia

Martin Šimkovič, Monika Motyčková, Pavel Vodárek, Lukáš Smolej

IV. interní hematologická klinika, Fakultní nemocnice a Univerzita Karlova v Praze, Lékařská fakulta v Hradci Králové

Chronic lymphocytic leukemia (CLL) occurs primarily in the elderly. The high prevalence of serious comorbidities, which may

have a major impact on the treatment course, is frequent in these patients. Recently, the focus of clinical research in CLL has

been shifted on the elderly and comorbid patients. Results of the randomized trials provided us a fundamental improvement of

treatment responses and prolonged overall survival. Chemoimmunotherapy combining chlorambucil with an anti-CD20 antibody

(obinutuzumab, ofatumumab a rituximab) is current standard approach for 1st line treatment of elderly/comorbid patients. Bendamustin

plus rituximab or dose attenuated FCR are other treatment options. Novel targeted therapy inhibiting B-cell receptor

signaling (ibrutinib and idelalisib) or anti-apoptotic bcl-2 protein (venetoclax) provided a revolutionary therapeutic improvement

particularly in relapsed/refractory CLL. Assessment of performance status, renal function, comorbidities and individual evaluation

of patient’s fitness may help us in treatment decision making.

Keywords: chronic lymphocytic leukemia, comorbidity, chemoimmunotherapy, ibrutinib, idelalisib

Published: June 1, 2017  Show citation