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New treatment approaches in CLL: Challenges and opportunities in the elderly

  • Barbara Eichhorst
    Correspondence
    Corresponding author at: German CLL Study Group, Department I of Internal Medicine, University Hospital Cologne, 50924 Cologne, Germany. Tel.: +49 221 478 88220; fax: +49 221 478 86886.
    Affiliations
    German CLL Study Group (GCLLSG), Department I of Internal Medicine, Center of Integrated Oncology Cologne–Bonn, University Hospital Cologne, Cologne, Germany
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  • Michael Hallek
    Affiliations
    German CLL Study Group (GCLLSG), Department I of Internal Medicine, Center of Integrated Oncology Cologne–Bonn, University Hospital Cologne, Cologne, Germany

    Excellence Cluster Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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  • Valentin Goede
    Affiliations
    German CLL Study Group (GCLLSG), Department I of Internal Medicine, Center of Integrated Oncology Cologne–Bonn, University Hospital Cologne, Cologne, Germany

    Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany
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Published:August 01, 2016DOI:https://doi.org/10.1016/j.jgo.2016.07.007

      Abstract

      The majority of patients with chronic lymphocytic leukemia (CLL) are over 70 years old. These patients vary in their vulnerability toward treatment efforts. Heterogeneity in fitness of older patients with CLL is mainly determined by individual differences in physiological aging and pathological conditions such as comorbidities and geriatric syndromes. Various options exist to treat older patients with CLL outside and inside clinical trials. Among these are new treatment approaches, including chemoimmunotherapy with engineered CD20 antibodies (e.g., obinutuzumab), single agent therapy with kinase inhibitors (e.g., ibrutinib, idelalisib), other targeted drug therapy (e.g., venetoclax, lenalidomide), and combinations of these novel compounds. Treatment recommendations for older patients take patient-related as well as disease-related risk factors into consideration. Emerging new treatment approaches in older patients offer novel opportunities, but also novel challenges which are discussed in this review.

      Keywords

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