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Review
. 2022 Nov 29;12(11):161.
doi: 10.1038/s41408-022-00756-9.

Chronic lymphocytic leukemia treatment algorithm 2022

Paul J Hampel  1 , Sameer A Parikh  2
Affiliations
Review

Chronic lymphocytic leukemia treatment algorithm 2022

Paul J Hampel et al. Blood Cancer J. .

Erratum in

Abstract

The treatment landscape for patients with chronic lymphocytic leukemia (CLL) has changed considerably with the introduction of very effective oral targeted therapies (such as Bruton tyrosine kinase inhibitors and venetoclax) and next-generation anti-CD20 monoclonal antibodies (such as obinutuzumab). These agents lead to improved outcomes in patients with CLL, even among those with high-risk features, such as del17p13 or TP53 mutation and unmutated immunoglobulin heavy chain (IGHV) genes. Selecting the right treatment for the right patient requires consideration of disease characteristics and prior treatment sequence, as well as patient preferences and comorbidities. The CLL-International Prognostic Index (CLL-IPI) remains the best-validated tool in predicting the time to first therapy among previously untreated patients, which guides selection for early intervention efforts. This review summarizes our current approach to the management of CLL, right from the time of diagnosis through relapsed disease.

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Conflict of interest statement

Research funding has been provided to the institution from Janssen, AstraZeneca, Merck, and Genentech for clinical studies in which Sameer A. Parikh is a principal investigator. Honoraria has been provided to the institution from Pharmacyclics, Merck, AstraZeneca, Genentech, Amgen, TG Therapeutics, Novalgen Limited, and AbbVie for Sameer A. Parikh’s participation in consulting activities/advisory board meetings.

Figures

Fig. 1
Fig. 1. Approach to the management of patients with newly diagnosed CLL who do not meet the 2018 International Workshop for Chronic Lymphocytic Leukemia (iwCLL) criteria for therapy.
Management is guided by risk-stratification, while including supportive care is necessary for all patients with a CLL diagnosis.
Fig. 2
Fig. 2. The CLL-International Prognostic Index (CLL-IPI) and Time to First Therapy (TTFT) among newly diagnosed CLL patients seen at Mayo Clinic, Rochester, MN.
Calculation of the CLL-IPI facilitates prognostic discussions regarding TTFT with newly diagnosed patients with CLL. FISH fluorescence in situ hybridization, IGHV immunoglobulin heavy chain gene, TTFT time to first therapy.
Fig. 3
Fig. 3
Approach to the management of patients with previously untreated CLL who meet the 2018 International Workshop for Chronic Lymphocytic Leukemia (iwCLL) criteria for therapy. BTKi Bruton tyrosine kinase inhibitors, IGHV immunoglobulin heavy chain gene.
Fig. 4
Fig. 4
Approach to the management of patients with relapsed CLL who meet the 2018 International Workshop for Chronic Lymphocytic Leukemia (iwCLL) criteria for therapy. BTKi Bruton tyrosine kinase inhibitors, IGHV immunoglobulin heavy chain gene, mAb monoclonal antibody.
See this image and copyright information in PMC

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