title: Management of elderly and unfit patients with chronic lymphocytic leukemia.
abstract: About 75% of patients with chronic lymphocytic leukemia (CLL) are more than 65 years at the time of diagnosis. Treatment of the elderly remains complicated due to multiple factors, such as comorbidities, decline in functional reserve and fitness. Since chronological age by itself cannot properly predict life expectancy and treatment tolerance, an accurate assessment of the fitness status is of crucial importance for an optimal treatment choice. Areas covered: This review will discuss the most relevant aspects concerning the issues experienced in the management of elderly/unfit patients with CLL. The most frequently observed age-related toxicities, fitness assessments, supportive care measures and treatment options for elderly patients and for patients who are deemed unfit will be discussed. Literature search methodology included examination of PubMed index. Expert commentary: During the last decade, different trials focusing on elderly/unfit patients have investigated more tolerable chemoimmunotherapy schedules and, more recently, the activity and safety of chemo-free regimens. Chlorambucil combined with an anti-CD20 monoclonal antibody has shown clinical activity with a relatively good profile of toxicity. The recent introduction of the B-cell receptor antagonists, ibrutinib and idelalisib, and other targeted drugs in development (e.g. venetoclax), is broadening the therapeutic armamentarium of elderly CLL patients.
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Francesca R
authors: FR
authors: Mauro
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Adriano
authors: A
authors: Salaroli
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Maria D
authors: MD
authors: Caputo
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Gioia
authors: G
authors: Colafigli
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Luigi
authors: L
authors: Petrucci
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Melissa
authors: M
authors: Campanelli
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Antonietta
authors: A
authors: Ferretti
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Anna R
authors: AR
authors: Guarini
authors: a Hematology, Department of Cellular Biotechnologies and Hematology , Policlinico Umberto 1 and Sapienza University , Rome , Italy.
authors: Robin
authors: R
authors: Foà
mesh_terms: D000367:Age Factors; D000066491:Clinical Decision-Making; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D015897:Comorbidity; D019468:Disease Management; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D063868:Patient Outcome Assessment; D017410:Practice Guidelines as Topic; D011379:Prognosis
keywords: Chronic lymphocytic leukemia; comorbidities; elderly; front-line treatment; older