Chronic Lymphocytic Leukemia in Elderly Patients: Own Experience

Abstract

Introduction. The annual incidence rate of chronic lymphocytic leukemia (CLL) in Europe is 1­4 per 100 000 population. The disease is more common in older patients. For many years treatment of CLL included single­agent chlorambucil or cyclophosphamide, later ­ a combination of vincristine, cyclophosphamide, prednisolone (COP) alone or with addition of doxorubicin (CHOP) was used. In recent years, the arsenal of antileukemic agents has expanded significantly (fludarabine, cladribine, bendamustine, rituximab and others), a combination of these me­ dications provides a high percentage of complete remissions, but because of its immunosuppressive effect, this treatment cannot be used in all patients. In particular, in patients with comorbidities and older patients. Therefore a considerable attention has been recently paid to the management of the older patients with CLL. The purpose of the study was to analyze the timeliness of CLL diagnosis and management of elderly patients according to data of the Consultative Polyclinics of SI “Institute of Blood Pathology and Transfusion Medicine NAMS of Ukraine”. Results and discussion. 114 CLL patients aged from 61 to 86 were recruited in the study. More than 1/3 of patients were diagnosed with CLL in the late stages of the disease course (III­IV Rai stage), which emphasizes the insufficient wariness for hematological disorders among family doctors and other medical specialists. Results of 2­20 years long observation show that the majority of the patients whose diagnosis was made on early stage (0­I Rai stage) are well and do not require treatment. Indications for initiation of treatment in elderly patients are the same as in younger ones. Short cycles of treatment with chlorambucil in patients aged 66­82 years result in partial remission with good patient condition and satisfactory quality of life with chlorambucil maintenance therapy dura­ tion from 24 to 132 months (at the time this publication was prepared). More aggressive therapy (bendamustine + rituximab and fludarabine + cyclophosphamide) in patients aged 66­79 years is more efficient in terms of obtaining complete remission, but is more toxic and can be used in elderly patients who underwent comprehensive geriatric assessment with preserved renal function and absence of comorbidities. Conclusions. Chlorambucil alone or combined with prednisone should be considered for the first­line therapy of CLL in elderly patients. More aggressive therapies (FC, BR regimens) should be applied at disease progression as treatment of the second line.

Keywords

• chemoimmunotherapy
• chlorambucil
• chronic lymphocytic leukemia
• elderly patients