Introduction: Upfront Treatment in Patients With CLL

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Moderator Myron Czuczman, MD, facilitates the discussion about the appropriate time to initiate therapy for a patient with chronic lymphocytic leukemia (CLL). With the recent approval of several new targeted agents and additional novel therapies development, the treatment of CLL has evolved significantly over the last decade. Therefore, the historical “watch-and-wait” approach has become a “watch-for-the-opportunity-that’s-coming” strategy, states John C. Byrd, MD.

Many patients may not need therapy immediately, as they may be asymptomatic with an excellent quality of life, cautions Thomas J. Kipps, MD. Subsequently, the temptation to treat with these novel agents should be resisted until patients are symptomatic. Richard Furman, MD, and others often must talk their patients out of therapy, with the caveat that there will be patients with 17p deletions or 11q deletions who may benefit from early treatment. Still, the heterogeneity in the clinical course for patients with this disease makes it imperative to consider not only risk factors, laboratory, and genomic findings but also the individual patient’s symptoms and performance status before initiating therapy.