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Chronic Lymphocytic Leukemia: Raising Expectations in the Treatment of Elderly Patients

Wolfgang Knauf and Daniel Re

Many advances have been seen in CLL treatment in recent years, primarily benefitting young, fit patients. However, CLL is primarily a disease of the elderly, and many elderly patients currently receive sub-optimal treatment. This is in part due to a lack of consensus surrounding how best to classify their health status. In order to ensure that elderly patients, whether ‘fit’ or ‘unfit’ receive the most appropriate treatment, there is a need for refinement of the screening tools currently used, and furthermore, a need for standardization. Treatment regimens such as FCR, currently considered the standard of care for CLL treatment, often cannot be recommended for elderly patients who are frequently ineligible for fludarabine-based therapy due to co-morbidities. Several targeted ‘chemotherapy-free’ treatments are being investigated for use in these patients. Additionally, less toxic chemotherapy regimens are under investigation, including chlorambucil and bendamustine, both in combination with the anti-CD20 antibodies rituximab and, more recently, obinutuzumab. Early results have been promising, and suggest the possibility of improved outcomes in this patient group who, actually, represent the majority of those with CLL.