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.