Für die Therapie der chronischen lymphatischen Leukämie (CLL) stehen inzwischen zahlreiche,
zielgerichtete Therapien zur Verfügung, die sowohl in der Erst- als auch in der Zweitlinientherapie
eine überlegene Wirksamkeit und eine längere Ansprechdauer im Vergleich zur Chemoimmuntherapie
zeigen. Insbesondere ältere und gebrechliche Patienten profitieren von der besseren
Verträglichkeit dieser Medikamente, die individuell unter Berücksichtigung von Begleiterkrankungen
und Komedikation eingesetzt werden.
Abstract
Nowadays, a wide range of targeted therapies are available for the treatment of chronic
lymphocytic leukemia, offering superior efficacy and a longer-lasting responses compared
to chemoimmunotherapy in both first- and second-line settings. Owing to the favorable
tolerability of novel targeted agents, genetic factors have superseded age and fitness
as key determinants in the selection of first-line therapy. Currently, high-risk genetic
features include del(17p13) or TP53 mutations, complex karyotype (≥3 chromosomal aberrations),
and unmutated IGHV status. Initial risk stratification focuses on detecting del(17p13)/TP53
mutations and assessing karyotype. This new strategy, along with the improved tolerability
of these agents, offers particular benefit to older and frail patients, with dosing
tailored to comorbidities and concomitant therapies.
Given the heterogeneity in older patients' health status, geriatric assessments (e.g.,
CIRS, FRAIL score) are additional key for individualized therapy decisions and adverse
events influence therapy choice (e.g. cardiovascular risk with BTK inhibitors. Beyond
clinical factors, patient preferences—such as opting for continuous (e.g., BTK inhibitor
monotherapy) versus time-limited therapy (e.g., venetoclax plus obinutuzumab or ibrutinib
plus venetoclax)—and treatment tolerability are decisive.
Schlüsselwörter
CLL Erstlinientherapie - zielgerichtete Therapie - älteren Patienten - BTK-Inhibitoren
CLL - Venetoclax Obinutuzumab - ohne Chemotherapie
Keywords
first-line therapy - targeted therapy - elderly patients - BTK inhibitors CLL -
Venetoclax Obinutuzumab - without chemotherapy
