Treating Older Patients with Chronic Lymphocytic Leukemia: A Personalized Approach

Median age at diagnosis for patients with chronic lymphocytic leukemia (CLL) is 72 years, and the number of older individuals affected by this condition is predicted to increase in the future as populations age. Contrary to common assumptions, CLL significantly affects the life expectancy of older individuals, frequently presenting at a more advanced stage and with more unfavorable features than in the younger population. Therefore, identifying the optimal treatment for these patients is a priority. Older patients with CLL are usually classified as fit, non-fit, or frail based on performance status and comorbidities, and several assessment tools can be used to make these evaluations. While supportive care is appropriate for frail patients, the remaining patients should be treated when indication criteria are met. Treatment options include chemoimmunotherapy, monoclonal antibody-based approaches (such as the use of rituximab, ofatumumab, or obinutuzumab) and, more recently, small molecules (such as ibrutinib, idelalisib, and venetoclax). The choice of treatment is guided by the patient's performance status and co-morbidities and by the disease characteristics, such as chromosomal and molecular abnormalities, and in patients with recurrent disease also by the type of prior regimen, their tolerability, and duration of response.