Management of chronic lymphocytic leukemia (CLL) in the elderly: a position paper from an international Society of Geriatric Oncology (SIOG) Task Force.
Chronic lymphocytic leukemia (CLL) mainly affects older people: the median age at diagnosis is > 70 years. Elderly patients with CLL are heterogeneous with regard both to the biology of their disease and aging. Following the diagnosis of CLL in an elderly individual, careful risk assessment is essential when treatment options are evaluated. This includes not only clinical staging and evaluation of disease-specific prognostic biomarkers such as 17p deletion and TP53 mutation, but also of comorbidities, physical capacity, nutritional status, cognitive capacity, ability to perform activities of daily living and social support. Comorbidity scoring and geriatric assessment tools are helpful in achieving such multidimensional evaluation in a systematic manner. The introduction of new drugs including novel monoclonal antibodies and kinase inhibitors offers enhanced opportunities for the treatment of elderly patients with CLL. This position paper of a Task Force of the International Society of Geriatric Oncology (SIOG) reviews currently available evidence relevant to such patients. All types of elderly patient (i.e. chronological age > 65-70 years) are considered, from robust (fit) to vulnerable (unfit) to the terminally ill. Among the topics covered are the following: (i) the relationship between chronological age, prognosis and survival, (ii) assessment of biological aging, (iii) biological age as a determinant of treatment feasibility and tolerance and (iv) tailoring of both first and further-line treatment to the circumstances of the individual patient.
Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
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R
Stauder
Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology (CIO) Cologne-Bonn, Cologne, Germany.
B
B
Eichhorst
Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands.
M E
ME
Hamaker
Department of Hematology, Volgograd Regional Clinical Oncology Center, Volgograd, Russian Federation.
K
K
Kaplanov
University of Minnesota, Hennepin County Medical Center, Minneapolis, USA.
V A
VA
Morrison
Karolinska University Hospital and Institute, Stockholm, Sweden.
A
A
Österborg
Russian Medical Academy for Postgraduate Education, Moscow, Russian Federation.
I
I
Poddubnaya
Department of Internal Medicine, Ohio State University, Ohio, USA.
J A
JA
Woyach
Department of Hematology and Oncology, Mayo Clinic, Rochester, USA.
T
T
Shanafelt
4th Department of Internal Medicine-Hematology, University Hospital and Charles University Faculty of Medicine, Hradec Králové, Czech Republic.
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L
Smolej
Hematology Department, IUC Toulouse-Oncopole, Toulouse, France.
L
L
Ysebaert
Department I of Internal Medicine, University Hospital Cologne, Center of Integrated Oncology (CIO) Cologne-Bonn, Cologne, Germany.
V
V
Goede
D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D015577:Geriatric Assessment; D006801:Humans; D007167:Immunotherapy; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008495:Medical Oncology; D009367:Neoplasm Staging; D011379:Prognosis; D018570:Risk Assessment; D016896:Treatment Outcome
assessment; chronic lymphocytic leukemia; comorbidity; elderly; frailty; targeted agents