Chronic lymphocytic leukemia in elderly patients

The majority of patients with chronic lymphocytic leukemia (CLL) are of advanced age and over 70 years old when the disease is diagnosed or requires therapy. Recently, new treatment options have emerged. This article gives a review of current diagnostics and therapy of CLL in elderly patients. A literature search was carried out in PubMed and in congress abstracts. The development and approval of new CD20 antibodies (e.g. ofatumumab, and obinutuzumab) as well as kinase inhibitors (e.g. ibrutinib and idelalisib) have broadened the therapeutic arsenal for elderly patients with CLL. Benefits from these advances have been mainly demonstrated for elderly patients with increased comorbidities and for elderly patients with high risk features (e.g. 17p deletion, p53 mutation and early relapse). For the former group of patients immunochemotherapy and no longer chemotherapy alone is the standard first-line treatment. In the latter group of patients early use of kinase inhibitors which block B-cell receptor signaling and can be taken orally are indicated. Studies are currently being carried out with further agents for targeted therapy (e.g. venetoclax, lenalidomide) as well as with tools for assessing patient fitness in elderly patients with CLL.