CLL in less fit patients (SLOW-GO).

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BlankChronic lymphocytic leukemia in less fit patients ( " SLOW-GO " ).

ID Giudice, FR Mauro, and R Foa

Leuk Lymphoma, July 21, 2011; .

Abstract The management of " slow-go " patients with chronic lymphocytic leukemia

(CLL) remains a primary unmet clinical need. This subgroup of patients,

underrepresented in clinical trials, represents the burden of CLL patients and

will progressively increase in future years. Diagnostic tools to identify this

patient population are emerging: the Cumulative Illness Rating Scale and

reproducible geriatric functionality tests should be included, in addition to

the traditional performance status assessment, in the work-up of elderly

patients prior to treatment, in order to use a common language and to better

focus the aims of therapy. Quality of life has to be preserved and evaluated

with dedicated tests. Evidence-based therapeutic strategies for " slow-go " CLL

patients are still lacking. Therefore, monotherapy with chlorambucil +/-

rituximab and possibly fludarabine or bendamustine remains a first-line option

outside clinical trials. Bendamustine + rituximab, pentostatin + rituximab +/-

cyclophosfamide, fludarabine + cyclophosphamide at reduced doses, chlorambucil

plus new anti-CD20 antibodies can be options to be assessed within clinical

trials, as their claimed acceptable toxicity is formally unproven. Clinical

trials specifically designed for " slow-go " CLL are strongly needed and the

enrollment of patients in dedicated trials is recommended. New

non-chemotherapeutic drugs could be also explored in this setting.

PMID: 21774745