Treatment Considerations

Factors influencing the choice of treatment include (Eichhorst et al., 2015; Hallek, 2015; Oscier et al., 2012; Stilgenbauer et al., 2015):

  • Fitness to tolerate chemotherapy and/or immunotherapy (i.e. myelosuppressive and immunosuppressive therapies) including:
    • age (e.g. >65 to 70)
    • performance status (e.g. Cumulative Illness Rating Scale (CIRS) score >6)
    • comorbidities (especially impaired renal function and creatinine clearance <60 mL/min)
    • susceptibility to infection.
  • Clinical stage of the disease
  • 17p deletion/TP53 mutation /genetic risk status
  • Previous or current immune cytopenias
  • Evidence of lymphomatous transformation (Richter syndrome/transformation).

In previously treated patients, consideration should also be given to:

  • Number and type of prior treatments and duration of response
  • Prior treatment efficacy and toxicity
  • Clonal evolution (in particular 17p deletion/TP53 mutation/genetic risk status)
  • Availability of a transplant donor in select cases.