Therapeutic potential of new B cell-targeted agents in the treatment of elderly and unfit patients with chronic lymphocytic leukemia

Table 1 NCCN-suggested treatment regimens^a for CLL [10]

Setting	Younger/fit patients^b	Elderly/physiologically unfit patients^c
First-line therapy	Chemoimmunotherapy	Obinutuzumab + chlorambucil
	FCR	Ofatumumab + chlorambucil
	FR	Rituximab + chlorambucil
	PCR	Bendamustine ± rituximab
	Bendamustine ± rituximab	Obinutuzumab
		Fludarabine ± rituximab
		Chlorambucil
		Rituximab
		Cladribine
Relapsed/refractory therapy (short response)^d	Ibrutinib	Ibrutinib
	Idelalisib ± rituximab	Idelalisib ± rituximab
	Chemoimmunotherapy	Chemoimmunotherapy
	FCR	Reduced-dose FCR
	PCR	Reduced-dose PCR
	Bendamustine ± rituximab	Bendamustine ± rituximab
	Fludarabine ± alemtuzumab	HDMP + rituximab
	RCHOP	Rituximab + chlorambucil
	OFAR	Ofatumumab
	Ofatumumab	Obinutuzumab
	Lenalidomide ± rituximab	Lenalidomide ± rituximab
	Alemtuzumab^e ± rituximab	Alemtuzumab^e ± rituximab
	HDMP + rituximab	Dose-dense rituximab

CLL chronic lymphocytic leukemia, FCR fludarabine, cyclophosphamide, and rituximab, FR fludarabine and rituximab, HDMP high-dose methylprednisolone, NCCN National Comprehensive Cancer Network, OFAR oxaliplatin, fludarabine, cytarabine, and rituximab, PCR pentostatin, cyclophosphamide, and rituximab, RCHOP rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone
^aCLL without del 11q or del 17 p; regimens are listed in order of preference
^bAge <70 years, or older patients without significant comorbidities
^cAge ≥70 years, or younger patients with comorbidities
^dIn patients with long response, suggested to re-treat as in first-line therapy until short response
^eAlemtuzumab is no longer commercially available for CLL

ISSN: 1756-8722