Treatment approach for elderly and unfit patients with chronic lymphocytic leukemia

Luca Laurenti, Idanna Innocenti, Francesco Autore, Raffaella Pasquale, Dimitar G Efremov

Risultato della ricerca: Contributo in rivistaArticolo in rivista

5 Citazioni (Scopus)

Abstract

Introduction: Elderly patients with chronic lymphocytic leukemia (CLL) or patients with comorbidities are often treated with chlorambucil (Chl) as front-line therapy despite relatively low response rates. The addition of a monoclonal anti-CD20 antibody to Chl substantially increases response rates and prolongs progression-free survival (PFS) in these patients, without increasing toxicity. As a result, the ESMO guidelines recommend that previously untreated CLL patients with relevant co-morbidity, but without TP53 deletion/mutation, should be treated with the combination of Chl plus an anti-CD20 antibody (rituximab, ofatumumab or obinutuzumab). Areas covered: This review focuses on the treatment approach of elderly and unfit patients with untreated chronic lymphocytic leukemia. Expert commentary: The addition of a monoclonal anti-CD20 antibody to Chl is currently the suggested treatment in this subset of CLL patients. The choice of the anti-CD20 antibody remains an open question, although obinutuzumab was found to be superior to rituximab, in a head-to-head comparison of Chl-based combinations, in untreated CLL patients with comorbidities, with higher progression free survival, complete remission rates and minimal residual disease-negative remissions. Because patients with a TP53 deletion/mutation are resistant to chemo-immunotherapy, treatment with the BTK inhibitor ibrutinib is recommended in this setting.
Lingua originaleEnglish
pagine (da-a)1069-1076
Numero di pagine8
RivistaExpert Review of Hematology
Volume10
DOI
Stato di pubblicazionePubblicato - 2017

Keywords

  • BCR inhibitors
  • CLL treatment
  • Elderly CLL patients
  • Hematology
  • chemo-immunotherapy
  • unfit CLL patients

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