Management of Frail Patients With CLL
Frailty defines a condition of shattered functional reserve, limited life expectancy and compromised capacity to tolerate even small stress. Sometimes in frail CLL patients life expectancy is shorter than expected from the aggressiveness of CLL, therefore achievement of complete remission, longer PFS or OS appear to be objectives of limited clinical relevance. A reasonable therapeutic approach for this subset of patients should be the control of symptoms using therapeutic agents with low potential of toxicity. The aim of such a palliative approach is to focus on the patient's wellbeing and improve the quality of life.
A relevant aspect concerns the potential reversibility of the frail condition. Currently, certain comorbidities may ameliorate and in some instances, following appropriate supportive care, patients can experience an upgrading of fitness status. This implies a short-term reassessment of functional status after appropriate correction of organ impairment.
When an antileukemic effect is required, chlorambucil, because of its favorable pharmacokinetic properties and toxicity profile appears a reasonable option of therapy in frail CLL patients. Recently updated NCCN guidelines suggest the option of associating rituximab with chlorambucil also in selected frail CLL patients. However, what should be kept in mind is that frailty includes a relatively heterogeneous range of conditions therefore the choice of treatment should be individualized offering a more effective therapy in highly selected CLL patients.
Expert Rev Hematol. 2013;6(4):441-449. © 2013 Expert Reviews Ltd.