Navigating the gap between guidelines and practical challenges in selecting first-line therapy for chronic...

Area of Science:

• Hematology
• Oncology
• Pharmacology

Background:

• Chronic lymphocytic leukemia (CLL) management has evolved from chemotherapy to targeted therapies, including BTK and BCL-2 inhibitors.
• Existing treatment guidelines may not fully address patient preferences, comorbidities, and logistical challenges in real-world settings.

Purpose of the Study:

• To address the limitations of current CLL treatment guidelines.
• To propose a personalized, patient-centered decision-making framework for frontline CLL therapy.

Main Methods:

• Review of challenges in frontline CLL therapy, focusing on BTK inhibitors and venetoclax-based regimens.
• Examination of patient stratification based on genetic markers (e.g., TP53 mutations/del(17p)) and geriatric assessments.
• Consideration of comorbidities such as cardiovascular disease and renal dysfunction.

Main Results:

• Current guidelines often fall short in addressing real-world patient needs and complexities.
• A practical framework integrating clinical, genetic, and logistical factors is needed for personalized CLL care.
• Patient preferences for oral regimens and quality of life are key considerations.

Conclusions:

• A patient-centered approach is essential for optimizing CLL treatment decisions.
• Future CLL treatment guidelines should prioritize personalized models that align with individual patient needs.
• Integrating patient-specific factors enhances decision-making and treatment outcomes in CLL management.