Patients with a high comorbidity burden (i.e. a CIRS score higher than 6) or relevant organ impairment should receive a therapy adapted to their physical status. This includes agents like chlorambucil in combination with a CD20 antibody, that is, rituximab, obinutuzumab or ofatumumab, bendamustine, and as of late, the bruton-tyrosine kinase inhibitor ibrutinib. For patients with del17p and possibly TP53 mutations, frontline treatment should be initiated with