Update on guidelines from the International Workshop on Chronic Lymphocytic Leukemia

This study reviewed updated guidelines for diagnosis, indications for treatment, response assessment and supportive management of chronic lymphocytic leukemia.

In 2008, the International Workshop on CLL (iwCLL) published guidelines for clinical trials for chronic lymphocytic leukemia (CLL) patients. These guidelines were revised from those previously published by the National Cancer Institute-sponsored Working Group. These guidelines provided definitions intended to standardize the assessment of patients. Since the 2008 edition of the guidelines, there have been improvements in the biology and treatment of patients with CLL. This has led to the iwCLL updating the 2008 guidelines.

The updated guidelines have several changes and additions. These updated recommendations have been made by iwCLL based on the latest scientific knowledge of CLL.

They have advised that mutations of genes in CLL such as the TP53 gene the IGHV gene are of clinical importance, and that patients should be tested for these and other mutations.

They have recommended updating the baseline assessment and prophylaxis (treatment given to prevent disease) of viral diseases before and during therapy of CLL.

They have highlighted the importance of assessing minimal residual disease (small number of cancer cells that remain when a patient is in remission). This is based on studies that have shown that treatments that lead to no MRD improve clinical outcomes.

They recommended an improved assessment of enlargement of the liver, spleen, and lymph nodes. An increase in size of these organs (of 50% or more) idicates disease progression.

They have advised of an updated response assessment for novel targeted drugs that need to be evaluated during continuous therapy. A response assessment is used to see patients response to a drug. In a continuous therapy (used as maintenance to prolong remission), patients should be evaluated at least 2 months after their best reponse is achieved.

The article reviewed the recommendations set out by iwCLL for diagnosis, indications for treatment, response assessment and supportive management of chronic lymphocytic leukemia.

Not all recommendations are based on a high level of evidence.