title: New treatment approaches in CLL: Challenges and opportunities in the elderly.
abstract: The majority of patients with chronic lymphocytic leukemia (CLL) are over 70years old. These patients vary in their vulnerability toward treatment efforts. Heterogeneity in fitness of older patients with CLL is mainly determined by individual differences in physiological aging and pathological conditions such as comorbidities and geriatric syndromes. Various options exist to treat older patients with CLL outside and inside clinical trials. Among these are new treatment approaches, including chemoimmunotherapy with engineered CD20 antibodies (e.g., obinutuzumab), single agent therapy with kinase inhibitors (e.g., ibrutinib, idelalisib), other targeted drug therapy (e.g., venetoclax, lenalidomide), and combinations of these novel compounds. Treatment recommendations for older patients take patient-related as well as disease-related risk factors into consideration. Emerging new treatment approaches in older patients offer novel opportunities, but also novel challenges which are discussed in this review.
authors.affiliation: German CLL Study Group (GCLLSG), Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany. Electronic address: barbara.eichhorst@uk-koeln.de.
authors.forename: Barbara
authors.initials: B
authors.lastname: Eichhorst
authors.affiliation: German CLL Study Group (GCLLSG), Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany; Excellence Cluster Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
authors.affiliation: German CLL Study Group (GCLLSG), Department I of Internal Medicine, Center of Integrated Oncology Cologne-Bonn, University Hospital Cologne, Cologne, Germany; Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany.
authors.forename: Valentin
authors.initials: V
authors.lastname: Goede
mesh_terms: D000367:Age Factors; D000368:Aged; D000074322:Antineoplastic Agents, Immunological / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D007167:Immunotherapy; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008495:Medical Oncology / Q000379:methods* / Q000592:standards; D058990:Molecular Targeted Therapy; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000074322:Antineoplastic Agents, Immunological
keywords: BCL2 inhibitor; Chemoimmunotherapy; Chronic lymphocytic leukemia; Kinase inhibitors