Management Considerations in CLL

Chronic lymphocytic leukemia (CLL) is the most common leukemia, accounting for about 15,000 new patients every year in the United States. CLL is a condition that people often live with for many years, so the prevalence is much higher. The disease is different from acute leukemias in that the indolent rate of progression offers most patients a favorable prognosis, and many patients will have normal life expectancy. That said, a small proportion CLL cases will progress rapidly and be life-threatening. As diagnostics have improved, clinicians are more commonly diagnosing CLL in younger patients and catching it in its earliest stages. The goal when managing CLL is to employ treatment as needed to ensure that overall survival and quality of life are optimized. The initial question to consider after diagnosis is whether or not patients require treatment. Asymptomatic patients who do not have significant cytopenias or organ dysfunction do not appear to benefit from earlier treatment. These CLL patients can be observed, sometimes lifelong, without chemotherapy or immunotherapy. If treatment is required, there are many new therapies that have emerged in recent years to effectively combat the disease. A Shift in Treatment CLL therapies have evolved significantly over time, causing a paradigm shift in treatment. Previously, CLL therapies could be used to improve symptoms but these agents did not frequently induce complete remission or improve survival. With the emergence and evolution of newer drugs, the durations of remission and survival rates have improved considerably. We now have therapies—used alone or in combination—that improve morbidity and even mortality associated with CLL. These therapies, along with the fact that CLL is being...