Treatment of chronic lymphocytic leukemia in older adults

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia and it typically afflicts older adults, with a median age at diagnosis of 71. Traditional treatments for CLL have included chemotherapy, which can often be difficult for older patients to tolerate. Given the variability in fitness, cognition and comorbidities amongst older patients, a geriatric evaluation should be considered prior to commencement of cytotoxic therapy. More recently, novel oral agents are proving to be both safe and effective in this population, redefining the field of CLL therapy. In this article we describe high and low-risk disease and discuss contemporary treatment paradigms. We will discuss how the inclusion of targeted therapies may improve outcomes in older patients with CLL being treated in the frontline and relapsed settings. Finally, we will touch on new treatments and combination therapies that are undergoing further study and discuss their potential utility in the older patient with CLL.