Management

The clinical course of chronic lymphocytic leukaemia (CLL) is highly variable and not all cases of CLL necessarily need to be treated or treated immediately (Pulte et al., 2015; Stilgenbauer et al., 2015). Factors affecting whether to treat or not, and which treatment to choose include age, comorbidities, prognostic markers, indolent or aggressive disease. Therefore, due to the complexity of the disease and patient status, there is a relative amount of variability in the choice of treatments used in CLL (Pulte et al., 2015).

The European Society of Medical Oncology (ESMO) published updated Clinical Practice Guidelines for the treatment of CLL (Eichhorst et al., 2017). The standard management of patients with early stage, asymptomatic disease remains a ‘watch-and-wait’ strategy and treatment should only be initiated in symptomatic patients meeting the criteria for “active disease” (Eichhorst et al., 2017).

International, European and UK guidelines make recommendations for both first-line and second-line treatment options, including timings for treatment initiation (Eichhorst et al., 2017; Ghielmini et al., 2013; Hallek et al., 2008; Hallek, 2015; Oscier et al., 2012; Stilgenbauer et al., 2015).

This section will include information as per the current guidelines on indications for treatment, choice of treatment, consolidation, autoimmune and infective complications, supportive care and stem cell transplantation.