Optimal management of older patients with chronic lymphocytic leukemia: some facts and principles guiding therapeutic choices.

Chronic lymphocytic leukemia (CLL) is a disease of older patients and median age at diagnosis is 72 years. This older group is under-represented in clinical trials, (median age 58-62 years). Here we review background data on incidence, survival, definitions of older age, fitness criteria, frailty and co-morbidities. Issues influencing the choice of therapy in older patients are also addressed and different therapeutic options are highlighted based on recent available data. Fit older patients with less co-morbidities benefit most from the very effective chemoimmunotherapy (FC-R) given for younger patients today, but whether other novel drug combinations or new agents are more suitable for less fit patients is still unsettled. Based on careful evaluation of published data from larger clinical trials and major referral centers we present our concept of therapy as a guide to optimal management for subgroups of older patients with CLL.