title: Management of chronic lymphocytic leukemia: practice guidelines from the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation.
abstract: OBJECTIVE
  The Italian Society of Hematology (SIE) and two affiliate societies (SIES and GITMO) commissioned a project to develop clinical practice guidelines for the treatment of chronic lymphocytic leukemia (CLL).
  
  
  METHODS
  Key questions in the management of patients with CLL were formulated by an Advisory Committee and approved by an Expert Panel of eight senior hematologists. After a systematic review of the literature, recommendations for disease-specific and supportive therapies were formulated and graded according to the supporting evidence. Explicit consensus methods were used for providing recommendations for questions with incomplete or potentially biased evidence.
  
  
  RESULTS
  It is recommended that therapy is commenced in patients with CLL when at least one of the following are present: B-symptoms, progressive/obstructive lymphadenopathy or organomegaly, rapid lymphocyte doubling time, anemia or thrombocytopenia (of new onset, worsening or steroid-resistant). It is recommended that patients without co-morbidity should receive fludarabine plus cyclophosphamide, whereas elderly patients with co-morbidity should receive oral chlorambucil. Younger patients with unfavorable biological risk factors should be considered for high-dose chemotherapy and autologous or allogeneic stem cell transplantation within approved clinical trials. Patients either relapsing rapidly after, or non-responsive to, first-line chlorambucil should receive fludarabine-containing regimens. Patients either relapsing soon after or not responding to fludarabine-based chemotherapy should be considered for schedules including non-cross-reactive agents, such as alemtuzumab, possibly followed by high-dose chemotherapy and autologous transplantation in the context of a clinical trial or by allogeneic stem cell transplantation.
  
  
  CONCLUSIONS
  We describe the results of a systematic literature review and an explicit approach to consensus techniques which resulted in recommendations for the key therapeutic decisions in patients with CLL.
authors.affiliation: Divisione di Ematologia, Azienda Ospedaliera Papardo, Messina, Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Brugiatelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bandini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barosi
authors.forename: Francesco
authors.initials: F
authors.lastname: Lauria
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Liso
authors.forename: Monia
authors.initials: M
authors.lastname: Marchetti
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Mauro
authors.forename: Giovanna
authors.initials: G
authors.lastname: Meloni
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Zinzani
authors.forename: Sante
authors.initials: S
authors.lastname: Tura
mesh_terms: D016026:Bone Marrow Transplantation / Q000592:standards*; D019468:Disease Management; D006405:Hematology / Q000592:standards*; D006801:Humans; D007558:Italy; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000628:therapy*; D012955:Societies, Medical / Q000592:standards*