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Chronic Lymphocytic Leukemia in Older Adults

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Geriatric Oncology

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Abstract

The typical patient with chronic lymphocytic leukemia (CLL) is old. For proper choice of therapy, older adults with CLL in need of treatment must be examined towards biological characteristics of their disease (presence or absence of 17p deletion or TP53 mutation) and their age (presence or absence of comorbidities or geriatric syndromes). Comorbidity scores and geriatric assessments could be supportive during fitness evaluation. Chemoimmunotherapy is a standard of care for older adults with previously untreated CLL lacking 17p deletion and TP53 mutation/dysfunction. Choice of the chemotherapy backbone (chlorambucil, bendamustine, fludarabine) and the antibody (rituximab, ofatumumab, obinutuzumab) depends on the fitness of the patient. The kinase inhibitor ibrutinib is a new therapeutic option in such patients and the treatment of choice for older adults with previously untreated CLL harboring 17p deletion or TP53 mutation. In addition to ibrutinib, idelalisib plus rituximab and venetoclax are preferred therapies for older adults with relapsed or refractory CLL. Readministration of chemoimmunotherapy is an option in older adults with late recurrence of CLL.

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References

  • Baumann T, Delgado J, Santacruz R, Martinez-Trillos A, Royo C, Navarro A, Pinyol M, Rozman M, Pereira A, Villamor N, Aymerich M, Lopez C, Carrio A, Montserrat E. Chronic lymphocytic leukemia in the elderly: clinico-biological features, outcomes, and proposal of a prognostic model. Haematologica. 2014;99:1599–604.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Binet JL, Leporrier M, Dighiero G, Charron D, D’Athis P, Vaugier G, Beral HM, Natali JC, Raphael M, Nizet B, Follezou JY. A clinical staging system for chronic lymphocytic leukemia: prognostic significance. Cancer. 1977;40:855–64.

    Article  CAS  PubMed  Google Scholar 

  • Burger JA, Tedeschi A, Barr PM, Robak T, Owen C, Ghia P, Bairey O, Hillmen P, Bartlett NL, Li J, Simpson D, Grosicki S, Devereux S, McCarthy H, Coutre S, Quach H, Gaidano G, Maslyak Z, Stevens DA, Janssens A, Offner F, Mayer J, O’Dwyer M, Hellmann A, Schuh A, Siddiqi T, Polliack A, Tam CS, Suri D, Cheng M, Clow F, Styles L, James DF, Kipps TJ. Ibrutinib as initial therapy for patients with chronic lymphocytic leukemia. N Engl J Med. 2015;373:2425–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Byrd JC, Brown JR, O'Brien S, Barrientos JC, Kay NE, Reddy NM, Coutre S, Tam CS, Mulligan SP, Jaeger U, Devereux S, Barr PM, Furman RR, Kipps TJ, Cymbalista F, Pocock C, Thornton P, Caligaris-Cappio F, Robak T, Delgado J, Schuster SJ, Montillo M, Schuh A, de Vos S, Gill D, Bloor A, Dearden C, Moreno C, Jones JJ, Chu AD, Fardis M, McGreivy J, Clow F, James DF, Hillmen P. Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. N Engl J Med. 2014;371:213–23.

    Article  PubMed  PubMed Central  Google Scholar 

  • Eichhorst BF, Busch R, Stilgenbauer S, Stauch M, Bergmann MA, Ritgen M, Kranzhofer N, Rohrberg R, Soling U, Burkhard O, Westermann A, Goede V, Schweighofer CD, Fischer K, Fink AM, Wendtner CM, Brittinger G, Dohner H, Emmerich B, Hallek M. First-line therapy with fludarabine compared with chlorambucil does not result in a major benefit for elderly patients with advanced chronic lymphocytic leukemia. Blood. 2009;114:3382–91.

    Article  CAS  PubMed  Google Scholar 

  • Eichhorst B, Robak T, Montserrat E, Ghia P, Hillmen P, Hallek M, Buske C. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v78–84.

    Article  PubMed  Google Scholar 

  • Eichhorst B, Fink AM, Bahlo J, Busch R, Kovacs G, Maurer C, Lange E, Koppler H, Kiehl M, Sokler M, Schlag R, Vehling-Kaiser U, Kochling G, Ploger C, Gregor M, Plesner T, Trneny M, Fischer K, Dohner H, Kneba M, Wendtner CM, Klapper W, Kreuzer KA, Stilgenbauer S, Bottcher S, Hallek M. First-line chemoimmunotherapy with bendamustine and rituximab versus fludarabine, cyclophosphamide, and rituximab in patients with advanced chronic lymphocytic leukaemia (CLL10): an international, open-label, randomised, phase 3, non-inferiority trial. Lancet Oncol. 2016a;17:928–42.

    Article  CAS  PubMed  Google Scholar 

  • Eichhorst B, Robak T, Montserrat E, Ghia P, Hillmen P, Hallek M, Buske C Appendix 6: Chronic lymphocytic leukaemia: eUpdate published online September 2016. Ann Oncol. 2016b;27:v143-v144. http://www.esmo.org/Guidelines/Haematological-Malignancies/Chronic-Lymphocytic-Leukaemia/eUpdate-Treatment-Recommendations

  • Ferrajoli A, O’Brien S, Wierda W, Lerner S, Faderl S, Kantarjian H, Keating MJ. Treatment of patients with CLL 70 years old and older: a single center experience of 142 patients. Leuk Lymph. 2005;46:S87. https://www.fda.gov/Drugs/DrugSafety/ucm490618.htm

  • Finnes HD, Chaffee KG, Call TG, Ding W, Bowen DA, Conte M, McCullough KB, Merten JA, Bartoo GT, Smith MD, Schwager SM, Slager SL, Kay NE, Shanafelt TD, Parikh SA. The importance of pharmacovigilance during ibrutinib therapy for chronic lymphocytic leukemia (CLL) in routine clinical practice. Blood. 2015;126:717.

    Google Scholar 

  • Fischer K, Fink A-M, Bishop H, Dixon M, Bahlo J, Choi MY, Weinkove R, Robinson KS, Dreyling M, Seiler T, Opat S, Owen C, Lopez J, Kutsch N, Tausch E, Ritgen M, Humerickhouse RA, Humphrey K, Wenger MK, Goede V, Eichhorst B, Wendtner C-M, Stilgenbauer S, Kipps TJ, Hallek M. Results of the safety run-in phase of CLL14 (BO25323): a prospective, open-label, multicenter randomized phase III trial to compare the efficacy and safety of obinutuzumab and venetoclax (GDC-0199/ABT-199) with obinutuzumab and chlorambucil in patients with previously untreated CLL and coexisting medical conditions. Blood. 2015;126:496.

    Google Scholar 

  • Fischer K, Bahlo J, Fink AM, Goede V, Herling CD, Cramer P, Langerbeins P, von Tresckow J, Engelke A, Maurer C, Kovacs G, Herling M, Tausch E, Kreuzer KA, Eichhorst B, Bottcher S, Seymour JF, Ghia P, Marlton P, Kneba M, Wendtner CM, Dohner H, Stilgenbauer S, Hallek M. Long-term remissions after FCR chemoimmunotherapy in previously untreated patients with CLL: updated results of the CLL8 trial. Blood. 2016;127:208–15.

    Article  CAS  PubMed  Google Scholar 

  • Flinn IW, Panayiotidis P, Afanasyev B, Janssens A, Grosicki S, Homenda W, Smolej L, Kuliczkowski K, Doubek M, Domnikova N, West SL, Chang CN, Barker AM, Gupta IV, Wright OJ, Offner F. A phase 2, multicenter study investigating ofatumumab and bendamustine combination in patients with untreated or relapsed CLL. Am J Hematol. 2016;91:900–6.

    Article  CAS  PubMed  Google Scholar 

  • Furman RR, Sharman JP, Coutre SE, Cheson BD, Pagel JM, Hillmen P, Barrientos JC, Zelenetz AD, Kipps TJ, Flinn I, Ghia P, Eradat H, Ervin T, Lamanna N, Coiffier B, Pettitt AR, Ma S, Stilgenbauer S, Cramer P, Aiello M, Johnson DM, Miller LL, Li D, Jahn TM, Dansey RD, Hallek M, O’Brien SM. Idelalisib and rituximab in relapsed chronic lymphocytic leukemia. N Engl J Med. 2014;370:997–1007.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Goede V, Raymonde B, Stilgenbauer S, Winter E, Fink A-M, Fischer K, Hallek M. Cumulative illness rating scale (CIRS) is a valuable tool to assess and weigh comorbidity in patients with chronic lymphocytic leukemia: results from the CLL8 trial of the German CLL study group. Haematologica. 2012;97:0154.

    Google Scholar 

  • Goede V, Cramer P, Busch R, Bergmann M, Stauch M, Hopfinger G, Stilgenbauer S, Dohner H, Westermann A, Wendtner CM, Eichhorst B, Hallek M. Interactions between comorbidity and treatment of chronic lymphocytic leukemia: results of German chronic lymphocytic leukemia study group trials. Haematologica. 2014a;99:1095–100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Goede V, Fischer K, Busch R, Engelke A, Eichhorst B, Wendtner CM, Chagorova T, de la Serna J, Dilhuydy MS, Illmer T, Opat S, Owen CJ, Samoylova O, Kreuzer KA, Stilgenbauer S, Dohner H, Langerak AW, Ritgen M, Kneba M, Asikanius E, Humphrey K, Wenger M, Hallek M. Obinutuzumab plus chlorambucil in patients with CLL and coexisting conditions. N Engl J Med. 2014b;370:1101–10.

    Article  CAS  PubMed  Google Scholar 

  • Goede V, Fischer K, Bosch F, Follows G, Frederiksen H, Cuneo A, Ludwig H, Crompton N, Maurer J, Uguen M, Fingerle-Rowson G, Hallek M. Updated survival analysis from the CLL11 study: obinutuzumab versus rituximab in chemoimmunotherapy-treated patients with chronic lymphocytic leukemia. Blood. 2015a;126:1733.

    Article  Google Scholar 

  • Goede V, Fischer K, Engelke A, Schlag R, Lepretre S, Montero LF, Montillo M, Fegan C, Asikanius E, Humphrey K, Fingerle-Rowson G, Hallek M. Obinutuzumab as frontline treatment of chronic lymphocytic leukemia: updated results of the CLL11 study. Leukemia. 2015b;29:1602–4.

    Article  CAS  PubMed  Google Scholar 

  • Goede V, Bahlo J, Chataline V, Eichhorst B, Durig J, Stilgenbauer S, Kolb G, Honecker F, Wedding U, Hallek M. Evaluation of geriatric assessment in patients with chronic lymphocytic leukemia: results of the CLL9 trial of the German CLL study group. Leuk Lymphoma. 2016a;57:789–96.

    Article  CAS  PubMed  Google Scholar 

  • Goede V, Bahlo J, Kutsch N, Fischer K, Fink AM, Fingerle-Rowson G, Stilgenbauer S, Bergmann M, Eichhorst B, Hallek M. Evaluation of the international prognostic index for chronic lymphocytic leukemia (CLL-IPI) in elderly patients with comorbidities: analysis of the CLL11 study population. Blood. 2016b;128:4401.

    Google Scholar 

  • Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Dohner H, Hillmen P, Keating MJ, Montserrat E, Rai KR, Kipps TJ. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the international workshop on chronic lymphocytic leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood. 2008;111:5446–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hallek M, Fischer K, Fingerle-Rowson G, Fink AM, Busch R, Mayer J, Hensel M, Hopfinger G, Hess G, von Grunhagen U, Bergmann M, Catalano J, Zinzani PL, Caligaris-Cappio F, Seymour JF, Berrebi A, Jager U, Cazin B, Trneny M, Westermann A, Wendtner CM, Eichhorst BF, Staib P, Buhler A, Winkler D, Zenz T, Bottcher S, Ritgen M, Mendila M, Kneba M, Dohner H, Stilgenbauer S. Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open-label, phase 3 trial. Lancet. 2010;376:1164–74.

    Article  CAS  PubMed  Google Scholar 

  • Hamaker ME, Mitrovic M, Stauder R. The G8 screening tool detects relevant geriatric impairments and predicts survival in elderly patients with a haematological malignancy. Ann Hematol. 2014a;93:1031–40.

    Article  CAS  PubMed  Google Scholar 

  • Hamaker ME, Prins MC, Stauder R. The relevance of a geriatric assessment for elderly patients with a haematological malignancy–a systematic review. Leuk Res. 2014b;38:275–83.

    Article  CAS  PubMed  Google Scholar 

  • Hamaker ME, Schiphorst AH, ten Bokkel HD, Schaar C, van Munster BC. The effect of a geriatric evaluation on treatment decisions for older cancer patients – a systematic review. Acta Oncol. 2014c;53:289–96.

    Article  PubMed  Google Scholar 

  • Herling CD, Klaumunzer M, Rocha CK, Altmuller J, Thiele H, Bahlo J, Kluth S, Crispatzu G, Herling M, Schiller J, Engelke A, Tausch E, Dohner H, Fischer K, Goede V, Nurnberg P, Reinhardt HC, Stilgenbauer S, Hallek M, Kreuzer KA. Complex karyotypes and KRAS and POT1 mutations impact outcome in CLL after chlorambucil-based chemotherapy or chemoimmunotherapy. Blood. 2016;128:395–404.

    Article  CAS  PubMed  Google Scholar 

  • Hillmen P, Robak T, Janssens A, Babu KG, Kloczko J, Grosicki S, Doubek M, Panagiotidis P, Kimby E, Schuh A, Pettitt AR, Boyd T, Montillo M, Gupta IV, Wright O, Dixon I, Carey JL, Chang CN, Lisby S, McKeown A, Offner F. Chlorambucil plus ofatumumab versus chlorambucil alone in previously untreated patients with chronic lymphocytic leukaemia (COMPLEMENT 1): a randomised, multicentre, open-label phase 3 trial. Lancet. 2015;385:1873–83.

    Article  CAS  PubMed  Google Scholar 

  • Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA. SEER cancer statistics review, 1975–2013. Bethesda: National Cancer Institute; 2016. http://seer.cancer.gov/csr/1975_2013/, based on November 2015 SEER data submission, posted to the SEER website, April 2016.

  • International CLL-IPI working group. An international progrnostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data. Lancet Oncol. 2015;17:779–90.

    Google Scholar 

  • Knauf WU, Lissichkov T, Aldaoud A, Liberati A, Loscertales J, Herbrecht R, Juliusson G, Postner G, Gercheva L, Goranov S, Becker M, Fricke HJ, Huguet F, Del Giudice I, Klein P, Tremmel L, Merkle K, Montillo M. Phase III randomized study of bendamustine compared with chlorambucil in previously untreated patients with chronic lymphocytic leukemia. J Clin Oncol. 2009;27:4378–84.

    Article  CAS  PubMed  Google Scholar 

  • Kovacs G, Bahlo J, Kluth S, Cramer P, Fink A-M, Fischer K, Gross-Ophoff-Mueller C, Langerbeins P, Maurer C, von Tresckow J, Wendtner C-M, Stilgenbauer S, Hallek M, Eichhorst B, Goede V. Prognostic impact and risk factors of reducing prescribed doses of fludarabine, cyclophosphamide and rituximab (FCR) during frontline treatment of chronic lymphocytic leukemia (CLL). Blood. 2015;126:4156.

    Google Scholar 

  • Lampson B, Matos T, Haesook K, Kassar S, Morgan E, Hirakawa M, Fein J, Fernandes S, Ritz J, Brown JR. Idelalisib given front-line for the treatment of chronic lymphocytic leukemia results in frequent and severe immune-mediated toxicities. Blood. 2015;126:497.

    Google Scholar 

  • Maddocks KJ, Ruppert AS, Lozanski G, Heerema NA, Zhao W, Abruzzo L, Lozanski A, Davis M, Gordon A, Smith LL, Mantel R, Jones JA, Flynn JM, Jaglowski SM, Andritsos LA, Awan F, Blum KA, Grever MR, Johnson AJ, Byrd JC, Woyach JA. Etiology of ibrutinib therapy discontinuation and outcomes in patients with chronic lymphocytic leukemia. JAMA Oncol. 2015;1:80–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Martell RE, Peterson BL, Cohen HJ, Petros WP, Rai KR, Morrison VA, Elias L, Shepherd L, Hines J, Larson RA, Schiffer CA, Hurwitz HI. Analysis of age, estimated creatinine clearance and pretreatment hematologic parameters as predictors of fludarabine toxicity in patients treated for chronic lymphocytic leukemia: a CALGB (9011) coordinated intergroup study. Cancer Chemother Pharmacol. 2002;50:37–45.

    Article  CAS  PubMed  Google Scholar 

  • Michallet AS, Aktan M, Schuh A, Widenius T, Johansson P, Raposo J, Meddeb B, Moreno C, Hiddemann W, Bernhardt A, Kellershohn K, Messeri D, Osborne S, Leblond V. Rituximab in combination with bendamustine or chlorambucil for the treatment of chronic lymphocytic leukaemia: primary results from the randomised phase IIIb MABLE study. Leuk Lymphoma. 2015;56S:88.

    Google Scholar 

  • Mulligan SP, Gill D, Turner P, Renwick WEP, Latimer M, Mackinlay N, Berkahn L, Simpson D, Campbell P, Forsyth CJ, Cull G, Harrup R, Sulda M, Best G, Bressel M, Di Iulio J, Kuss BJ. A randomised dose de-escalation study of oral fludarabine, ±oral cyclophosphamide and intravenous rituximab as first-line therapy of fit patients with chronic lymphocytic Leukaemia (CLL) aged ≥65 years: final analysis of response and toxicity. Blood. 2014;124:3325.

    Google Scholar 

  • Nikitin E, Kisilichina D, Zakharov O, Lugovskaya S, Varlamova E, Obukhova T, Biderman B, Kaplanskaya I, Naumova E, Pochtar M, Sudarikov A, Domracheva E, Ivanova V, Kovaleva L, Ptushkin V. Randomised comparison of FCR-lite and CLR (chlorambucil plus rituximab) regimens in elderly patients with chronic lymphocytic leukemia. Haematologica. 2013;98:1147.

    Article  Google Scholar 

  • O’Brien S, Furman RR, Coutre SE, Sharman JP, Burger JA, Blum KA, Grant B, Richards DA, Coleman M, Wierda WG, Jones JA, Zhao W, Heerema NA, Johnson AJ, Izumi R, Hamdy A, Chang BY, Graef T, Clow F, Buggy JJ, James DF, Byrd JC. Ibrutinib as initial therapy for elderly patients with chronic lymphocytic leukaemia or small lymphocytic lymphoma: an open-label, multicentre, phase 1b/2 trial. Lancet Oncol. 2014;15:48–58.

    Article  PubMed  Google Scholar 

  • O’Brien SM, Lamanna N, Kipps TJ, Flinn I, Zelenetz AD, Burger JA, Keating M, Mitra S, Holes L, Yu AS, Johnson DM, Miller LL, Kim Y, Dansey RD, Dubowy RL, Coutre SE. A phase 2 study of idelalisib plus rituximab in treatment-naive older patients with chronic lymphocytic leukemia. Blood. 2015;126:2686–94.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46:219–34.

    CAS  PubMed  Google Scholar 

  • Roberts AW, Davids MS, Pagel JM, Kahl BS, Puvvada SD, Gerecitano JF, Kipps TJ, Anderson MA, Brown JR, Gressick L, Wong S, Dunbar M, Zhu M, Desai MB, Cerri E, Heitner Enschede S, Humerickhouse RA, Wierda WG, Seymour JF. Targeting BCL2 with venetoclax in relapsed chronic lymphocytic leukemia. N Engl J Med. 2016;374:311–22.

    Article  CAS  PubMed  Google Scholar 

  • Schiphorst AH, Ten Bokkel Huinink D, Breumelhof R, Burgmans JP, Pronk A, Hamaker ME. Geriatric consultation can aid in complex treatment decisions for elderly cancer patients. Eur J Cancer Care (Engl). 2016;25:365–70.

    Article  CAS  Google Scholar 

  • Shanafelt TD, Rabe KG, Kay NE, Zent CS, Jelinek DF, Reinalda MS, Schwager SM, Bowen DA, Slager SL, Hanson CA, Call TG. Age at diagnosis and the utility of prognostic testing in patients with chronic lymphocytic leukemia. Cancer. 2010;116:4777–87.

    Article  PubMed  PubMed Central  Google Scholar 

  • Soumerai JD, Barrientos JC, Hallek M, Kipps TJ, Jones JA, Stilgenbauer S, Xing G, Yao N, Ysebaert L, Zelenetz AD. An evaluation of the chronic lymphocytic leukemia (CLL) international prognostic index as a prognostic tool in patients with relapsed/refractory CLL in idelalisib phase 3 randomized studies. J Clin Oncol. 2016;34:7513.

    Google Scholar 

  • Stauder R, Eichhorst B, Hamaker B, Kaplanov K, Morrison V, Österborg A, Poddubnaya I, Woyach JA, Shanafelt T, Smolej L, Ysebaert L, Goede V. Management of chronic lymphocytic leukemia (CLL) in the elderly: a position paper from an International Society of Geriatric Oncology (SIOG) task force. Ann Oncol. 2017;28:218–27.

    Google Scholar 

  • Stilgenbauer S, Eichhorst B, Schetelig J, Coutre S, Seymour JF, Munir T, Puvvada SD, Wendtner CM, Roberts AW, Jurczak W, Mulligan SP, Bottcher S, Mobasher M, Zhu M, Desai M, Chyla B, Verdugo M, Enschede SH, Cerri E, Humerickhouse R, Gordon G, Hallek M, Wierda WG. Venetoclax in relapsed or refractory chronic lymphocytic leukaemia with 17p deletion: a multicentre, open-label, phase 2 study. Lancet Oncol. 2016;17:768–78.

    Article  CAS  PubMed  Google Scholar 

  • Thompson PA, Tam CS, O'Brien SM, Wierda WG, Stingo F, Plunkett W, Smith SC, Kantarjian HM, Freireich EJ, Keating MJ. Fludarabine, cyclophosphamide, and rituximab treatment achieves long-term disease-free survival in IGHV-mutated chronic lymphocytic leukemia. Blood. 2016;127:303–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Thurmes P, Call T, Slager S, Zent C, Jenkins G, Schwager S, Bowen D, Kay N, Shanafelt T. Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia. Leuk Lymphoma. 2008;49:49–56.

    Article  PubMed  Google Scholar 

  • Truger MS, Jeromin S, Weissmann S, Dicker F, Kern W, Schnittger S, Haferlach T, Haferlach C. Accumulation of adverse prognostic markers worsens prognosis in chronic lymphocytic leukaemia. Br J Haematol. 2015;168:153–6.

    Article  PubMed  Google Scholar 

  • Zelenetz AD, Gordon LI, Wierda W, Abramson JS, Advani RH, Andreadis CB, Bartlett N, Byrd JC, Caimi P, Fayad LE, Fisher RI, Glenn MJ, Habermann TM, Lee Harris N, Hoppe RT, Horwitz SM, Kaminski MS, Kelsey CR, Kim YH, Krivasic S, LaCasce AS, Martin MG, Nademanee A, Porcu P, Press O, Rabinovitch R, Reddy N, Reid E, Roberts K, Saad AA, Snyder ED, Sokol L, Swinnen LJ, Vose JM, Yahalom J. NCCN clinical practice guideline: chronic lymphocytic leukemia/small lymphocytic lymphoma. 2016. https://www.nccn.org/professionals/physician_gls/f_guidelines.asp

  • Zent CS, Burack WR. Mutations in chronic lymphocytic leukemia and how they affect therapy choice: focus on NOTCH1, SF3B1, and TP53. Hematology Am Soc Hematol Educ Program. 2014;2014:119–24.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. GCLLSG Study Office, Department I of Internal Medicine, University Hospital of Cologne, Centre of Integrated Oncology (CIO) Cologne-Bonn, Cologne, Germany

    Valentin Goede, Michael Hallek & Barbara Eichhorst

  2. Division of Oncogeriatrics, Department of Geriatric Medicine, St. Marien Hospital, Cologne, Germany

    Valentin Goede

  3. Excellence Cluster Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany

    Michael Hallek

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  1. Valentin Goede
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Correspondence to Valentin Goede .

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  1. Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA

    Martine Extermann

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  1. Comprehensive Cancer Center of Wake Forest University, Winston-Salem, USA

    Heidi Klepin

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Goede, V., Hallek, M., Eichhorst, B. (2018). Chronic Lymphocytic Leukemia in Older Adults. In: Extermann, M. (eds) Geriatric Oncology . Springer, Cham. https://doi.org/10.1007/978-3-319-44870-1_43-1

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