ESMO Clinical Practice Guideline update: management of chronic lymphocytic leukaemia


  • Heather Mason
  • Univadis Medical News
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The European Society for Medical Oncology (ESMO) has published updated recommendations for the management of chronic lymphocytic leukaemia (CLL). The update has been published in Annals of Oncology.

Highlights:

  • Prognosis and treatment decisions in CLL depend on genetic and clinical factors including age, stage, and comorbidities
  • Therapies targeting B-cell-receptor pathway or defect mechanism of apoptosis induce long-lasting remissions.

Key recommendations:

  • Routine screening for CLL is not recommended, either in the general population or in relatives of patients with CLL.
  • Diagnosis is usually possible by immunophenotyping of peripheral blood only.
  • Lymph node biopsy and/or bone marrow biopsy may be helpful if immunophenotyping is not conclusive.
  • Binet and Rai staging with clinical symptoms are relevant for treatment indication.
  • del(17p), TP53 mutations and Ig heavy chain variable (IGHV) status are relevant for the choice of therapy and should be assessed prior to treatment.
  • The standard treatment of patients with early asymptomatic disease is a watch-and-wait strategy.
  • Routine imaging during a watch-and-wait period is not recommended unless there are clinical symptoms.
  • Decision for type of front-line treatment is based on TP53 mutation or del(17p), IGHV mutational status, age, comorbidities and comedication.