Jacqueline C. Barrientos, MD, associate professor, The Feinstein Institute for Medical Research, discusses the management of elderly patients with chronic lymphocytic leukemia (CLL).
Jacqueline C. Barrientos, MD, associate professor, The Feinstein Institute for Medical Research, Northwell Health, discusses the management of elderly patients with chronic lymphocytic leukemia (CLL).
Elderly patients have many comorbidities that may affect their ability to tolerate any particular therapy in CLL, states Barrientos. By the time that these patients require therapy, most of them have at least 4 comorbidities such as high blood pressure, cardiac disease, or a high risk for kidney or liver disease. Chemoimmunotherapy regimens, like fludarabine, cyclophosphamide, and rituximab (Rituxan; FCR) and bendamustine and rituximab (BR) do not work well because patients get infections, myelosuppression, and require blood transfusions or hospitalizations.
According to Barrientos, there are new data stating that the BTK inhibitor ibrutinib (Imbruvica) works well. There is long-term follow-up of 31 patients that were treatment naïve, older than 65, and received therapy 5 years later. Only 2 patients have stopped responding.