How I Treat Elderly or Comorbid Patients with Chronic Lymphocytic Leukemia
Treatment of chronic lymphocytic leukemia (CLL) has recently undergone several major changes. Most importantly, large randomized trials (CLL-8 in first line and REACH in relapse) clearly demonstrated superiority of chemoimmunotherapy consisting of fludarabine, cyclophosphamide and rituximab (FCR) ov...
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| Format: | Article |
| Language: | English |
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Karolinum Press
2010-01-01
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| Series: | Acta Medica |
| Subjects: | |
| Online Access: | https://actamedica.lfhk.cuni.cz/53/4/0213/ |
| _version_ | 1811261444365221888 |
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| author | Lukáš Smolej |
| author_facet | Lukáš Smolej |
| author_sort | Lukáš Smolej |
| collection | DOAJ |
| description | Treatment of chronic lymphocytic leukemia (CLL) has recently undergone several major changes. Most importantly, large randomized trials (CLL-8 in first line and REACH in relapse) clearly demonstrated superiority of chemoimmunotherapy consisting of fludarabine, cyclophosphamide and rituximab (FCR) over fludarabine and cyclophosphamide (FC) alone, thus establishing FCR regimen as the new gold standard in younger and physically fit patients. However, management of elderly and/or comorbid patients is still a challenging task because they cannot be treated with agressive approaches due to high risk of unacceptable toxicity. To date, no randomized trials in this patient population have improved therapeutic results over chlorambucil; therefore, this agent remains the backbone of treatment against which the new protocols should be tested. When deciding about the intensity of treatment, performance status, biological age and number as well as severity of comorbidities should be taken into account. Emerging treatment concepts for elderly/comorbid patients include combination of chlorambucil with monoclonal antibodies (rituximab, ofatumumab, GA-101), fludarabine-based regimens in reduced doses or protocols based on bendamustine and lenalidomide. Combination of highdose steroids with rituximab represent a promising option in relapsed/refractory CLL; however, infectious toxicity remains a serious issue. Finally, ofatumumab monotherapy appears to be a safe and effective therapy for heavily pretreated patients with CLL. This article reviews the current and future possibilities in the treatment of elderly and comorbid patients with CLL. |
| first_indexed | 2024-04-12T19:04:29Z |
| format | Article |
| id | doaj.art-8f26a7dc2dd74840983d5a0498a457c4 |
| institution | Directory Open Access Journal |
| issn | 1211-4286 1805-9694 |
| language | English |
| last_indexed | 2024-04-12T19:04:29Z |
| publishDate | 2010-01-01 |
| publisher | Karolinum Press |
| record_format | Article |
| series | Acta Medica |
| spelling | doaj.art-8f26a7dc2dd74840983d5a0498a457c42022-12-22T03:20:03ZengKarolinum PressActa Medica1211-42861805-96942010-01-0153421322010.14712/18059694.2016.79How I Treat Elderly or Comorbid Patients with Chronic Lymphocytic LeukemiaLukáš Smolej0Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, 2nd Department of Medicine, Department of Hematology, Czech RepublicTreatment of chronic lymphocytic leukemia (CLL) has recently undergone several major changes. Most importantly, large randomized trials (CLL-8 in first line and REACH in relapse) clearly demonstrated superiority of chemoimmunotherapy consisting of fludarabine, cyclophosphamide and rituximab (FCR) over fludarabine and cyclophosphamide (FC) alone, thus establishing FCR regimen as the new gold standard in younger and physically fit patients. However, management of elderly and/or comorbid patients is still a challenging task because they cannot be treated with agressive approaches due to high risk of unacceptable toxicity. To date, no randomized trials in this patient population have improved therapeutic results over chlorambucil; therefore, this agent remains the backbone of treatment against which the new protocols should be tested. When deciding about the intensity of treatment, performance status, biological age and number as well as severity of comorbidities should be taken into account. Emerging treatment concepts for elderly/comorbid patients include combination of chlorambucil with monoclonal antibodies (rituximab, ofatumumab, GA-101), fludarabine-based regimens in reduced doses or protocols based on bendamustine and lenalidomide. Combination of highdose steroids with rituximab represent a promising option in relapsed/refractory CLL; however, infectious toxicity remains a serious issue. Finally, ofatumumab monotherapy appears to be a safe and effective therapy for heavily pretreated patients with CLL. This article reviews the current and future possibilities in the treatment of elderly and comorbid patients with CLL.https://actamedica.lfhk.cuni.cz/53/4/0213/Chronic lymphocytic leukemiaComorbidityHealth-related quality of lifeCreatinine clearanceElderly patientsLow-dose fludarabine |
| spellingShingle | Lukáš Smolej How I Treat Elderly or Comorbid Patients with Chronic Lymphocytic Leukemia Acta Medica Chronic lymphocytic leukemia Comorbidity Health-related quality of life Creatinine clearance Elderly patients Low-dose fludarabine |
| title | How I Treat Elderly or Comorbid Patients with Chronic Lymphocytic Leukemia |
| title_full | How I Treat Elderly or Comorbid Patients with Chronic Lymphocytic Leukemia |
| title_fullStr | How I Treat Elderly or Comorbid Patients with Chronic Lymphocytic Leukemia |
| title_full_unstemmed | How I Treat Elderly or Comorbid Patients with Chronic Lymphocytic Leukemia |
| title_short | How I Treat Elderly or Comorbid Patients with Chronic Lymphocytic Leukemia |
| title_sort | how i treat elderly or comorbid patients with chronic lymphocytic leukemia |
| topic | Chronic lymphocytic leukemia Comorbidity Health-related quality of life Creatinine clearance Elderly patients Low-dose fludarabine |
| url | https://actamedica.lfhk.cuni.cz/53/4/0213/ |
| work_keys_str_mv | AT lukassmolej howitreatelderlyorcomorbidpatientswithchroniclymphocyticleukemia |