Current Standard of Care for Frontline CLL

John M. Pagel, MD, PhD:In 2020 we still approach patients with chronic lymphocytic leukemia [CLL] as we have for the past many years, in that we need to make sure we have a reason to treat them before we embark on a therapeutic regimen. So watch and wait—or what I think is a better term to use, active surveillance—is still an appropriate approach for patients with CLL in 2020. You have to have a reason to treat someone. Why is that? Of course, remember, we don’t cure people with standard treatments with CLL. But importantly, we’ve had such important therapies and developments over the last many years that have translated to significant improvements in outcomes for patients, including helping them live longer. Data clearly show that over the last many years survival continues to improve, again because of targeted therapies and new novel treatments.

When we have a reason to treat patients—and we know what those reasons are because they are well defined. They may be someone who is having symptoms—fevers, weight loss, and a variety of other factors, such as a rapidly doubling white blood count or a particular lymphocyte count, a higher burden of disease, or higher genetic risk—those patient factors all actually drive and facilitate the indication and need for therapy.

When we approach a patient, remember that most of these patients are a bit older. The median age of these patients is close to 70 years old, meaning by the time patients even relapse they’re going to be in their 70s or even 80s. Understanding the journey for these patients and understanding that we don’t cure them with standard treatments makes the goal for these patients really tolerability of therapy, maximizing their quality of life, and helping them live for as long as possible in a very good, low-disease-burden state.

Transcript edited for clarity.