Chronic lymphocytic leukemia in older adults

Abstract

The typical patient with chronic lymphocytic leukemia (CLL) is old. For proper choice of therapy, older adults with CLL in need of treatment must be examined towards biological characteristics of their disease (presence or absence of 17p deletion or TP53 mutation) and their age (presence or absence of comorbidities or geriatric syndromes). Comorbidity scores and geriatric assessments could be supportive during fitness evaluation. Chemoimmunotherapy is a standard of care for older adults with previously untreated CLL lacking 17p deletion and TP53 mutation/dysfunction. Choice of the chemotherapy backbone (chlorambucil, bendamustine, fludarabine) and the antibody (rituximab, ofatumumab, obinutuzumab) depends on the fitness of the patient. The kinase inhibitor ibrutinib is a new therapeutic option in such patients and the treatment of choice for older adults with previously untreated CLL harboring 17p deletion or TP53 mutation. In addition to ibrutinib, idelalisib plus rituximab and venetoclax are preferred therapies for older adults with relapsed or refractory CLL. Readministration of chemoimmunotherapy is an option in older adults with late recurrence of CLL.