Chronic lymphocytic leukemia: planning for an aging population

Abstract

Chronic lymphocytic leukemia (CLL) remains incurable, but over the past decade there have been major advances in the understanding of the pathophysiology of CLL and in the treatment of this disease. This has led to greatly increased response rates and durations of response, as well as improved survival. CLL is a disease of the elderly and not all patients are eligible for the aggressive upfront chemoimmunotherapy regimens that are resulting in improved response rates and survival, so what is the optimal treatment approach for more frail elderly patients? It is highly likely that our treatment approaches will continue to evolve as the results of ongoing clinical trials are released. The age range of patients involved in clinical trials is not representative of this disease, and more research is required in patients who are representative of the majority of CLL patients seen in practice before we will see outcome improvements in these more elderly and often more frail patient populations.

Keywords::

• chronic lymphocytic leukemia
• clinical trials
• comorbidity
• elderly
• treatment

Financial & competing interests disclosure

John G Gribben has received honoraria for consultancy and for speaking from Roche, Celgene, Biogen and Mundipharma, and funding from the NIH for the CLL Research Consortium Program Grant (NCI PO1 CA81538). The author has no other 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 apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

aADL: Advance activities of daily living; ADL: Activities of daily living; CIRS: Cumulative illness rating score; iADL: Instrumental activities of daily living.