Diagnostic and therapeutic recommendations of the Polish Society of Hematology and Transfusion Medine and Polish Adult Leukemia Group – CLL for chronic lymphocytic leukemia in 2014

Abstract

Chronic lymphocytic leukemia (CLL) is predominantly a disease of the elderly, with a median age of 70 years at diagnosis. Appropriate treatment approach requires physical examination, evaluation of performance status, co-morbidities and severity of comorbid conditions, biological age, peripheral, blood count with morphologic examination. In addition, in some patients bone marrow evaluation, serum biochemistry including serum lactate dehydrogenasis and β₂-microglobulin, Coombs’ test, imaging of adenomegalies, assessed either by CT scan or by the combination of chest X-ray and abdomen ultrasound should be incorporated into decision-making process with regard to intensity of treatment. In patients requiring therapy, particularly a second-line treatment, del 17p and/or p53 mutations should be also checked. Elderly and/or comorbid patients with CLL may not tolerate more aggressive approach due to high risk of unacceptable toxicity of purine nucleoside analogs, especially in combination with cyclophosphamide and rituximab. Therefore in these patients population, chlorambucil +/- rituximab is still accepted as the first-line treatment and chlorambucil remains the backbone of treatment against which the new protocols should be tested. The results of ongoing trials investigating the role of new immunochemotherapies and the other novel agents will probably modify the treatment of CLL in the following years. In this article we present recommendations for diagnosis, prognosis and therapy of CLL elaborated by by PTH i T and PALG-CLL group.