New Directions in CLL: A Review of 2019 Treatment Guideline Updates in USA

[Jm954]

In December 2018, pivotal trial data were presented at the American Society of Hematology Annual Meeting that demonstrated promising results for the first-line treatment of patients with CLL and SLL. In particular, new courses of CLL care in several patient populations emerged from the findings of 3 trials.

The impact of these studies is reinforced by the updates to the 2019 NCCN guidelines for the treatment of CLL. The updated guidelines reflect the increased consideration now given to frailty, significant comorbidities, age, del(17p)/TP53 mutation status, and immunoglobulin heavy-chain variable (IGHV) mutation status in patients with CLL (Table). This article reviews the guideline updates for these groups of patients:

1. First-Line Options Combined for Frail Patients With Significant Comorbidity, Patients Older Than 65 Years, and Younger Patients With Significant Comorbidities Without del(17p)/TP53 Mutation

2. First-line Therapy for Patients Younger Than 65 Years Without Significant Comorbidties and Without del(17p)/TP53 Mutation

3. Relapsed/Refractory Therapy for Patients With Relapsed/Refractory CLL/SLL Without del(17p)/TP53 Mutation

4. Unmutated IGHV

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Jackie