Chronic Lymphocytic Leukemia in the Elderly, Which Investigations Are Necessary: A Map for the Practicing Oncologist

Pinilla‐Ibarz, Javier; Emole, Josephine

doi:10.1177/107327481502204s03

Cited by 6 publications

(16 citation statements)

References 69 publications

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“…All individuals 70 years of age and older should undergo a comprehensive geriatric assessment before initiation of therapy to estimate cancer-independent mortality risk and tolerance of chemotherapy and to identify conditions that may interfere with the treatment [6]. Several tools are available for assessment of comorbidities, functional status, and risk of chemotherapy toxicity for elderly patients with cancer [7].…”

Section: Tools For Assessing Comorbiditiesmentioning

confidence: 99%

Treatment of Chronic Lymphocytic Leukemia in the Elderly

Hamed¹

2017

CTOIJ

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Elderly patients have a more limited bone marrow reserve in comparison with younger patients and may recover more slowly from drug-related cytopenias. Age-related decline in renal and hepatic function may delay clearance of antileukemic agents cleared by liver and kidney, necessitating their dose reduction. Comorbidities have been postulated to contribute to CLL-unrelated death, facilitate toxicity to CLL treatment, predispose to earlier progression of leukemic disease, and result in a higher rate of CLL-related deaths.

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Section: Tools For Assessing Comorbiditiesmentioning

confidence: 99%

Treatment of Chronic Lymphocytic Leukemia in the Elderly

Hamed¹

2017

CTOIJ

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“…The literature searches yielded 854 publications; 17 of the publications were identified as highly relevant to the patient experience [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. A review of these publications yielded 27 concepts considered to be related to CLL and/or its treatment.…”

Section: Review Of Literature Patient Blogs and Forumsmentioning

confidence: 99%

Development of a Conceptual Model of Chronic Lymphocytic Leukemia to Better Understand the Patient Experience

Eek

Blowfield

Krogh

et al. 2020

Patient

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Background and Objective Understanding the patient experience is important for identifying the unmet need in chronic lymphocytic leukemia. The current study aimed to develop a comprehensive chronic lymphocytic leukemia conceptual model. Methods The conceptual model was based on literature searches, review of chronic lymphocytic leukemia patient blogs/ forums, and interviews with five expert clinicians, with 20 patients who received at most one treatment (first line) for their chronic lymphocytic leukemia, and with 20 patients with relapsed or refractory chronic lymphocytic leukemia. De-identified interviews were transcribed, coded, and evaluated using qualitative data analysis software. Results Thirty-five prevalent chronic lymphocytic leukemia-related symptom and impact concepts were identified from literature searches, patient blogs/forums, and clinician interviews. Patient interviews confirmed the identified concepts and revealed five additional concepts. Fatigue-related sub-components were identified from how patients described their fatigue, covering symptoms (tiredness/need for sleep, lack of energy, weakness, cognitive fatigue), and impacts (decreased ability to maintain their social, familial, or professional role, decreased physical functioning, frustration). Three versions of the conceptual model were created: an overall model with all concepts; a model highlighting the most prominent concepts in first line; and a model highlighting the most prominent concepts in relapsed or refractory disease. Prominent concepts in both first line and relapsed or refractory disease were fatigue-related symptoms and impacts, muscle/joint aches, night sweats, bruising, fever, recurrent infections/illness, insomnia, decreased cognitive/emotional functioning, anxiety/worry, stress, depression, financial difficulty, and fear of death. Dyspnea and cough were prominent in first line only, and enlarged lymph nodes, headaches, pain/discomfort, weight loss, nausea/vomiting, and infusion reactions were prominent in relapsed or refractory disease only. Conclusions The results show that fatigue is a dominant issue affecting patients with chronic lymphocytic leukemia. The three versions of the conceptual model can help researchers to understand patients' unmet needs and guide the patient-reported outcome strategy for clinical trials.

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“…4 CLL is an appropriate model to explore these issues, as age is universally recognized to be a poor prognostic factor for CLL, 2 and novel agents promise to modify the natural history of the disease. [5][6] Some of these agents-including ibrutinib, idelalisib, obinutuzumab, and ofatumumab-lack major toxicities and therefore are particularly promising for older individuals. Aging represents a progressive loss in the functional reserve of multiple organ systems and for that reason is associated with reduced tolerance of stress.…”

Section: Editorialmentioning

confidence: 99%

“…Consequently, some of the most effective treatments for CLL, such as the combination of fludarabine, cyclophosphamide, and rituximab (FCR) or bone marrow transplant in 17p deleted/TP53-mutated disease may be contraindicated in the majority of individuals 70 years of age and older. [5][6] After an overview of the epidemiology 2 and treatment strategies 6 for CLL, this special issue of Cancer Control examines the approach to CLL in older individuals. 5 As expected in a scientific treatise, new conclusions and new questions are offered.…”

Section: Editorialmentioning

confidence: 99%