The APLC expert consensus recommendations on the management of chronic lymphocytic leukaemia in Asia

Targeted therapies have significantly transformed the management of chronic lymphocytic leukaemia (CLL), yet most recommendations continue to reflect Western practice patterns. Variations in disease biology, healthcare resources and treatment accessibility across the Asia-Pacific (APAC) necessitate region-specific guidance. The Asia-Pacific Leukaemia Consortium (APLC) therefore developed updated consensus statements to support standardised, context-appropriate care for patients with CLL.

A modified Delphi process was conducted with 17 haematology experts from multiple APAC regions. A systematic literature search (i.e. MEDLINE via PubMed) covering publications from 2016 onwards informed the development of 29 statements across 3 domains: diagnosis, treatment and long-term management. Panel members rated each statement using a 5-point Likert scale. Consensus was defined a priori as a mean score ≥3.5. Statistical measures and iterative expert discussions guided refinement of the final recommendations.

Twenty-nine statements reached consensus with key recommendations addressing: (1) appropriate use of genetic and prognostic testing, particularly TP53 and immunoglobulin heavy chain (IGHV) status; (2) first-line and relapsed/refractory treatment selection, including the role of Bruton's tyrosine kinase (BTK) inhibitors, B-cell lymphoma 2 inhibitors, combination strategies, cellular therapies and emerging modalities; and (3) long-term monitoring, toxicity surveillance and management of complications such as autoimmune cytopenias. Regionspecific considerations-such as variable access to novel agents and diagnostic platforms-were incorporated throughout.

These updated APLC consensus recommendations provide clinicians across the APAC with an evidence-based, pragmatic framework for managing CLL. They aim to support treatment consistency, optimise sequencing strategies and address gaps in diagnostics, access and long-term survivorship care across diverse healthcare settings.