Dr. Kahl on Considerations for Treatment Strategies in CLL

Brad Kahl, MD, professor in the Department of Medicine, Washington University School of Medicine, Siteman Cancer Center, discusses factors to consider when choosing appropriate treatment strategies for patients with chronic lymphocytic leukemia (CLL).

Physicians should take comorbidities into account when choosing treatment, as there are large disparities across all patients with CLL, Kahl says. For example, a 72-year-old patient could be in very good health, while a 62-year-old patient could be in poor health. However, when weighing considerations, age is still an important factor to consider, he adds. Bone marrow health naturally diminishes with age, so this factor alone should keep physicians from prescribing certain treatment regimens.

Kahl says that even if a 70-year-old patient with CLL is in extremely good health, he still would not consider them for the standard regimen of fludarabine, cyclophosphamide, and rituximab (Rituxan). The fitness of an older patient does not matter in this situation as age alone would make this treatment strategy too risky.

Other factors to consider are disease characteristics, such as chromosomal abnormalities. For example, patients with a 17p abnormality or a p53 mutation, should not receive chemoimmunotherapy as ibrutinib might be a stronger option for them. Immunoglobulin heavy chain gene mutational status is another factor to consider, he adds, because patients with unmutated disease do not respond as well to chemoimmunotherapy.