Treatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review

Chronic lymphocytic leukemia (CLL) incidence increases with age reaching 37.9/100,000 in patients over 85 years. Although there is no standardized geriatric tool specifically validated for CLL, a correct framing of the fitness status is of critical importance to individualize treatment strategies. B...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Alberto Fresa, Francesco Autore, Eugenio Galli, Annamaria Tomasso, Luca Stirparo, Idanna Innocenti, Luca Laurenti
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	chronic lymphocytic leukemia elderly comorbidities targeted therapy Medicine R
Acceso en línea:	https://doaj.org/article/bb44eb70a48d474689f67be0d09c9237
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:bb44eb70a48d474689f67be0d09c9237
record_format	dspace
spelling	oai:doaj.org-article:bb44eb70a48d474689f67be0d09c92372021-11-11T17:43:31ZTreatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review10.3390/jcm102151042077-0383https://doaj.org/article/bb44eb70a48d474689f67be0d09c92372021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/5104https://doaj.org/toc/2077-0383Chronic lymphocytic leukemia (CLL) incidence increases with age reaching 37.9/100,000 in patients over 85 years. Although there is no standardized geriatric tool specifically validated for CLL, a correct framing of the fitness status is of critical importance to individualize treatment strategies. Based on the evidence available to date, frontline chemoimmunotherapy has an increasingly narrowing application, being eligible for candidacy only in elderly fit patients without or with minimal geriatric syndromes. On the other hand, treatment with BCR inhibitors, monotherapy, or in combination with anti-CD20 antibodies (e.g., obinutuzumab), must be preferred both for frontline and relapsed CLL not only in unfit patients, but also in fit patients with unmutated IGHV or harboring del(17p) and/or TP53 mutations/deletions. Second-generation inhibitors (e.g., acalabrutinib, zanubrutinib, pirtobrutinib) are novel compounds that, due to their better safety profile and different specificity, will help physicians overcome some of the safety issues and treatment resistances. In the era of targeted therapies, treatment decisions in elderly and/or unfit patients with CLL must be a balance between efficacy and safety, carefully evaluating comorbidities and geriatric syndromes to ensure the best approach to improve both quality of life and life expectancy.Alberto FresaFrancesco AutoreEugenio GalliAnnamaria TomassoLuca StirparoIdanna InnocentiLuca LaurentiMDPI AGarticlechronic lymphocytic leukemiaelderlycomorbiditiestargeted therapyMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5104, p 5104 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	chronic lymphocytic leukemia elderly comorbidities targeted therapy Medicine R
spellingShingle	chronic lymphocytic leukemia elderly comorbidities targeted therapy Medicine R Alberto Fresa Francesco Autore Eugenio Galli Annamaria Tomasso Luca Stirparo Idanna Innocenti Luca Laurenti Treatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review
description	Chronic lymphocytic leukemia (CLL) incidence increases with age reaching 37.9/100,000 in patients over 85 years. Although there is no standardized geriatric tool specifically validated for CLL, a correct framing of the fitness status is of critical importance to individualize treatment strategies. Based on the evidence available to date, frontline chemoimmunotherapy has an increasingly narrowing application, being eligible for candidacy only in elderly fit patients without or with minimal geriatric syndromes. On the other hand, treatment with BCR inhibitors, monotherapy, or in combination with anti-CD20 antibodies (e.g., obinutuzumab), must be preferred both for frontline and relapsed CLL not only in unfit patients, but also in fit patients with unmutated IGHV or harboring del(17p) and/or TP53 mutations/deletions. Second-generation inhibitors (e.g., acalabrutinib, zanubrutinib, pirtobrutinib) are novel compounds that, due to their better safety profile and different specificity, will help physicians overcome some of the safety issues and treatment resistances. In the era of targeted therapies, treatment decisions in elderly and/or unfit patients with CLL must be a balance between efficacy and safety, carefully evaluating comorbidities and geriatric syndromes to ensure the best approach to improve both quality of life and life expectancy.
format	article
author	Alberto Fresa Francesco Autore Eugenio Galli Annamaria Tomasso Luca Stirparo Idanna Innocenti Luca Laurenti
author_facet	Alberto Fresa Francesco Autore Eugenio Galli Annamaria Tomasso Luca Stirparo Idanna Innocenti Luca Laurenti
author_sort	Alberto Fresa
title	Treatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review
title_short	Treatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review
title_full	Treatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review
title_fullStr	Treatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review
title_full_unstemmed	Treatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review
title_sort	treatment options for elderly/unfit patients with chronic lymphocytic leukemia in the era of targeted drugs: a comprehensive review
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/bb44eb70a48d474689f67be0d09c9237
work_keys_str_mv	AT albertofresa treatmentoptionsforelderlyunfitpatientswithchroniclymphocyticleukemiaintheeraoftargeteddrugsacomprehensivereview AT francescoautore treatmentoptionsforelderlyunfitpatientswithchroniclymphocyticleukemiaintheeraoftargeteddrugsacomprehensivereview AT eugeniogalli treatmentoptionsforelderlyunfitpatientswithchroniclymphocyticleukemiaintheeraoftargeteddrugsacomprehensivereview AT annamariatomasso treatmentoptionsforelderlyunfitpatientswithchroniclymphocyticleukemiaintheeraoftargeteddrugsacomprehensivereview AT lucastirparo treatmentoptionsforelderlyunfitpatientswithchroniclymphocyticleukemiaintheeraoftargeteddrugsacomprehensivereview AT idannainnocenti treatmentoptionsforelderlyunfitpatientswithchroniclymphocyticleukemiaintheeraoftargeteddrugsacomprehensivereview AT lucalaurenti treatmentoptionsforelderlyunfitpatientswithchroniclymphocyticleukemiaintheeraoftargeteddrugsacomprehensivereview
_version_	1718432023097376768

Treatment Options for Elderly/Unfit Patients with Chronic Lymphocytic Leukemia in the Era of Targeted Drugs: A Comprehensive Review

Ejemplares similares