Treatment of Elderly Patients With Chronic Lymphocytic Leukemia

B: Bendamustine; CLB: Chlorambucil; CR: Complete remission; O: Ofatumumab; PFS: Progression-free survival; R: Rituximab.

Authors and Disclosures

Stefano Molica*¹, Maura Brugiatelli², Fortunato Morabito³, Felicetto Ferrara⁴, Emilio Iannitto⁵, Nicola Di Renzo⁶, Silvana Capalbo⁷, Pellegrino Musto⁸ and Francesco Di Raimondo<sup>9

1</sup>Dipartimento Onco-Ematologico Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
²Struttura Complessa di Ematologia, Azienda Ospedaliera Papardo, Messina, Italy
³UOC Ematologia, Azienda Ospedaliera, Cosenza, Italy
⁴Dipartimento Oncoematologico, Dipartimento di Ematologia – Azienda Ospedaliera di rilievo Nazionale A. Cardarelli, Napoli, Italy
⁵Struttura Complessa di Ematologia Ospedale 'S. G. Moscati', Taranto, Italy
⁶UOC Ematologia e Trapianti, ASL Lecce, Lecce, Italy
⁷Struttura Complessa di Ematologia, Ospedali Riuniti, Azienda Ospedaliera-Universitaria, Foggia, Italy
⁸Struttura Complessa di Ematologia e Trapianto di Cellule Staminali, IRCCS della Basilicata (CROB), Rionero in Vulture, Potenza, Italy
⁹Department of Clinical and Molecular Bio-Medicine, Section of Hematology, Oncology and Clinical Pathology, University of Catania, Italy

Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.

* Author for correspondence
smolica@libero.it

Sidebar

Key Issues

• The incidence of chronic lymphocytic leukemia (CLL) is dramatically increased in elderly patients although knowledge on how to treat them in day-to-day practice is still incomplete. Moreover, there are few randomized trials comparing different strategies and many questions remain unanswered.

• Current recommendations suggest treating elderly CLL patients with good physical status and low burden of comorbidities with chemoimmunotherapy, consisting of non-fludarabine-based regimens. On the other hand, results based on the analysis of patients enrolled onto successive first-line CALGB CLL trials show that frontline therapy with fludarabine does not improve outcomes for older adults with CLL as compared with chlorambucil.

• The use of chlorambucil, as a single agent, remains a reasonable treatment option for elderly patients with comorbidities while bendamustine may represent another treatment option for these patients.

• Further work should clarify the role of small molecule inhibitors in older patients as well as identify predictive factors of response and toxicity.