Table 3. Algorithm for frontline... | American Society of Hematology

Table 3.

Algorithm for frontline treatment in CLL

Clinical stage of disease	Del(17p) and/or TP53 mutation	Physical fitness	Recommendation for frontline treatment
Asymptomatic Binet A-B or Rai 0-II	Irrelevant	Irrelevant	Watch and wait until symptomatic
SymptomaticBinet C or Rai III-IV*	Not present	Fit	FCR†; → Consider BR, if >65 y
	Not present	Unfit	Chlorambucil + obinutuzumab or chlorambucil + ofatumumab or ibrutinib
	Present	Irrelevant	Ibrutinib → Consider venetoclax or idelalisib + rituximab if unsuitable for ibrutinib
	Frail (no-go)	Irrelevant	Best supportive care

Clinical stage of disease	Del(17p) and/or TP53 mutation	Physical fitness	Recommendation for frontline treatment
Asymptomatic Binet A-B or Rai 0-II	Irrelevant	Irrelevant	Watch and wait until symptomatic
SymptomaticBinet C or Rai III-IV*	Not present	Fit	FCR†; → Consider BR, if >65 y
	Not present	Unfit	Chlorambucil + obinutuzumab or chlorambucil + ofatumumab or ibrutinib
	Present	Irrelevant	Ibrutinib → Consider venetoclax or idelalisib + rituximab if unsuitable for ibrutinib
	Frail (no-go)	Irrelevant	Best supportive care

BR, bendamustine and rituximab; FCR, fludarabine, cyclophosphamide and rituximab.

In general, clinical trials should be offered, if available.

Other purine analogs-based chemoimmunotherapy, according to national guidelines.