Join John Byrd, MD, and Gerard Lozanski, MD, as they present their multidisciplinary expertise on a range of cases pertaining to CLL/SLL.

Chronic lymphocytic leukemia (CLL) remains the most commonly diagnosed leukemia among adults in the U.S.; the median age at diagnosis is 72 years, with approximately 70% of patients diagnosed at age ≥ 65 years (and 43% diagnosed at age ≥ 75 years). Thus, CLL mainly affects older adults, which poses important challenges with regards to the treatment approach of this disease. Chlorambucil, with or without rituximab, remains an accepted frontline treatment for older or frail adults who cannot tolerate more aggressive therapies. Additional strategies are needed to improve outcomes for older patients while minimizing the risks for treatment-related toxicities. In a recent phase II study, the immunomodulating agent lenalidomide demonstrated promising single-agent activity in previously untreated, older patients with CLL (median age: 71 years). Lenalidomide is also being evaluated in combination with rituximab in both the frontline and relapsed/refractory settings, including in older patient populations. Bendamustine was previously shown to be more effective than chlorambucil in frontline CLL, and may have a potential role in the management of older patients with CLL as single agent or in combination with rituximab. Several novel therapeutic agents that target specific signaling pathways in B-cell malignancies are under active clinical investigation. CAL-101 (GS-1101) is a selective small molecule inhibitor of PI3k-delta, and ibrutinib (PCI-32765) is an oral small molecule inhibitor of BTK; both agents are currently under evaluation for the treatment of CLL and NHL and may hold promise in the treatment of older patients with CLL. Clinicians should understand the unique challenges that face older patients who often present with multiple comorbidities and may have decreased tolerance for aggressive regimens. The past few years have seen developments in new agents or novel combination regimens that may have a role in the treatment of older patients with CLL. There is a need for clinicians to evaluate available data from recent clinical trials and to incorporate new findings to the management of their older patient population, as appropriate.