Regional Standardization of CLL Management: Results of a Delphi Consensus Process

Area of Science:

• Hematology
• Oncology
• Clinical Medicine

Background:

• Chronic lymphocytic leukemia (CLL) treatment has advanced with Bruton tyrosine kinase and BCL-2 inhibitors.
• Treatment selection is complex for older CLL patients with comorbidities and frailty.
• Improved survival necessitates optimized, patient-centered management strategies.

Purpose of the Study:

• To achieve expert consensus on key aspects of CLL management in older adults.
• To address clinical heterogeneity and support real-world decision-making.
• To identify priorities for patient-centered, multidimensional CLL care.

Main Methods:

• A two-round Delphi consensus process involving 15 hematologists.
• Development of 12 statements on CLL management, including infectious risk, frailty, and TP53 alterations.
• Consensus defined as ≥70% agreement/disagreement on a Likert scale.

Main Results:

• Consensus was reached on 10 out of 12 statements after two rounds.
• Strong agreement was observed for five statements, with moderate convergence on others.
• Panelists stressed systematic infectious risk assessment and the utility of frailty tools (e.g., ECOG, Clinical Frailty Scale).

Conclusions:

• Therapeutic decisions for older CLL patients must balance genetic risk (e.g., TP53) with age, comorbidities, and frailty.
• Infectious risk assessment and frailty evaluation are crucial for patient stratification.
• This initiative can inform optimized care pathways for multidimensional CLL management.