Treatment of elderly patients with chronic lymphocytic leukemia
- 1 January 2009
- journal article
- review article
- Published by Taylor & Francis Ltd in Leukemia & Lymphoma
- Vol. 50 (2), 171-178
- https://doi.org/10.1080/10428190802688517
Abstract
Chronic lymphocytic leukemia (CLL) is dramatically increased in patients above the age of 65 years up to an incidence rate of 22–30/100 000. Although elderly patients represent the largest group of CLL patients they are clearly underrepresented in clinical trials. One important prognostic factor in the elderly is the burden of comorbidity. Survival is significantly impaired in CLL patients with multiple comorbidities (≥2) or with severe comorbidity (Charlson score ≥2). Therefore, not only age but also the incidence and burden of comorbidity should influence the choice of treatment strategy for every patient individually. A reliable tool for measuring comorbidity is the Cumulative Illness Rating Scale. The German CLL Study Group (GCLLSG) has used this tool within their clinical trials to distinguish between physically fit and non-fit patients. Although chlorambucil is still the standard treatment of choice in non-fit patients, dose-reduced purine analogue-based combination therapies with or without immunotherapy are currently investigated within clinical trials. Because full-dosed combination treatment might cause increased toxicity rates in relapse situation, dose-reduced combination therapies should be considered in this situation. An adequate supportive treatment is necessary for the prevention of toxicities as well as for the improvement of health-related quality of life. In summary, the treatment decision in elderly CLL patients is carefully to be made in each patient individually considering not only the stage and risk factors of the disease but also the patients' physical condition and social environment.This publication has 35 references indexed in Scilit:
- Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemiaLeukemia & Lymphoma, 2008
- Assessment of fludarabine plus cyclophosphamide for patients with chronic lymphocytic leukaemia (the LRF CLL4 Trial): a randomised controlled trialThe Lancet, 2007
- Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemiaBlood, 2007
- Phase III Trial of Fludarabine Plus Cyclophosphamide Compared With Fludarabine for Patients With Previously Untreated Chronic Lymphocytic Leukemia: US Intergroup Trial E2997Journal of Clinical Oncology, 2007
- Fludarabine plus cyclophosphamide versus fludarabine alone in first-line therapy of younger patients with chronic lymphocytic leukemiaBlood, 2005
- Chemoimmunotherapy With Fludarabine, Cyclophosphamide, and Rituximab for Relapsed and Refractory Chronic Lymphocytic LeukemiaJournal of Clinical Oncology, 2005
- Early Results of a Chemoimmunotherapy Regimen of Fludarabine, Cyclophosphamide, and Rituximab As Initial Therapy for Chronic Lymphocytic LeukemiaJournal of Clinical Oncology, 2005
- Randomized phase 2 study of fludarabine with concurrent versus sequential treatment with rituximab in symptomatic, untreated patients with B-cell chronic lymphocytic leukemia: results from Cancer and Leukemia Group B 9712 (CALGB 9712)Blood, 2002
- Genomic Aberrations and Survival in Chronic Lymphocytic LeukemiaThe New England Journal of Medicine, 2000
- Fludarabine Compared with Chlorambucil as Primary Therapy for Chronic Lymphocytic LeukemiaThe New England Journal of Medicine, 2000