The International Society of Geriatric Oncology (SIOG) published a position paper for the management of elderly patients with chronic lymphocytic leukemia (CLL) in the Annals of Oncology.1

The median age of CLL diagnosis in the United States is age 71, with 70% of patients age 65 or older. Elderly patients are, however, under-represented in most clinical trials.

The position paper was developed by a Task Force by conducting literature searches, and the initial position was reviewed by the authors and an SIOG-appointed panel. Levels of evidence were not assigned to the recommendations because there is a paucity of randomized trial data in this setting.

The position paper highlights that chronologic age alone should not be used to estimate life expectancy. Physiologic age is also a major contributor to life expectancy.

Other important factors include comorbidities, functional capacities, and lifestyle. A geriatric assessment can predict patient outcomes and guide treatment decisions.

The position paper categorizes elderly patients according to their fitness, comorbidities, and geriatric impairments. The panel recommends that patients with normal renal function and no comorbidities or geriatric impairments should be considered for intensive therapy. Patients with abnormal renal function, comorbidities, or geriatric impairments should be considered for adapted therapy. Patients with a life expectancy of less than 3 months should be considered for supportive care only.

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The panel recommends that very fit patients receive fludarabine, cyclophosphamide, and rituximab. Ofatumumab, obinutuzumab, or rituximab plus chlorambucil or single-agent ibrutinib should be considered for first-line therapy in vulnerable patients, whereas ibrutinib or idelalisib plus rituximab should be considered for relapsed/refractory CLL with a 17p-deletion/p53 mutation.

Reference

  1. Stauder R, Eichhorst B, Hamaker ME, et al.  Management of chronic lymphocytic leukemia (CLL) in the elderly: a position paper from an International Society of Geriatric Oncology (SIOG) Task Force. Ann Oncol. 2016 Nov 1. doi: 10.1093/annonc/mdw547 [Epub ahead of print]