Overview
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults in Western countries, typically diagnosed around age 72 1. It is characterized by the proliferation of mature B lymphocytes 1.Diagnosis
Diagnosis requires the presence of ≥5 × 10^9/L lymphocytes in peripheral blood, with >90% being small, mature lymphocytes 1.
Immunophenotypic confirmation of a B-cell clone expressing CD5, CD19, and CD23 is necessary 1.Management
Treatment initiation is indicated for symptomatic patients with criteria for active disease according to iwCLL guidelines 1.
Targeted therapies are prioritized over immunochemotherapy 1.
For first-line treatment in patients with del(17p) and/or TP53 mutation, a second-generation covalent Bruton's tyrosine kinase inhibitor (BTKi) administered indefinitely is the preferred option 1.
For patients without del(17p) or TP53 mutation and with mutated IGHV, time-limited therapy with a combination regimen is recommended 1.Key Recommendations
In first-line treatment, for patients with del(17p) and/or TP53 mutation, the best therapeutic option is a second-generation covalent Bruton's tyrosine kinase inhibitor (BTKi) administered indefinitely 1. (Evidence: Strong)
Treatment should be initiated in symptomatic patients with criteria for active disease according to iwCLL 1. (Evidence: Expert opinion)
Prioritize targeted therapies over immunochemotherapy in the management of CLL 1. (Evidence: Expert opinion)References
1 Medina Á, Muntañola A, Crespo M, Ramírez Á, Hernández-Rivas JÁ, Abrisqueta P et al.. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia and small lymphocytic lymphoma from Chronic Lymphocytic Leukemia Spanish Group (GELLC). Medicina clinica 2025. link