Chronic lymphocytic leukemia (CLL) mainly affects older people: the median age at diagnosis is > 70 years. Elderly patients with CLL are heterogeneous with regard both to the biology of their disease and aging. Following the diagnosis of CLL in an elderly individual, careful risk assessment is essential when treatment options are evaluated. This includes not only clinical staging and evaluation of disease-specific prognostic biomarkers such as 17p deletion and TP53 mutation, but also of comorbidities, physical capacity, nutritional status, cognitive capacity, ability to perform activities of daily living and social support. Comorbidity scoring and geriatric assessment tools are helpful in achieving such multidimensional evaluation in a systematic manner. The introduction of new drugs including novel monoclonal antibodies and kinase inhibitors offers enhanced opportunities for the treatment of elderly patients with CLL. This position paper of a Task Force of the International Society of Geriatric Oncology (SIOG) reviews currently available evidence relevant to such patients. All types of elderly patient (i.e. chronological age > 65-70 years) are considered, from robust (fit) to vulnerable (unfit) to the terminally ill. Among the topics covered are the following: (i) the relationship between chronological age, prognosis and survival, (ii) assessment of biological aging, (iii) biological age as a determinant of treatment feasibility and tolerance and (iv) tailoring of both first and further-line treatment to the circumstances of the individual patient.

4th Department of Internal Medicine Hematology University Hospital and Charles University Faculty of Medicine Hradec Králové Czech Republic

Department 1 of Internal Medicine University Hospital Cologne Center of Integrated Oncology Cologne Bonn Cologne Germany

Department of Geriatric Medicine Diakonessenhuis Utrecht The Netherlands

Department of Hematology and Oncology Mayo Clinic Rochester USA

Department of Hematology Volgograd Regional Clinical Oncology Center Volgograd Russian Federation

Department of Internal Medicine 5 Innsbruck Medical University Innsbruck Austria

Department of Internal Medicine Ohio State University Ohio USA

Hematology Department IUC Toulouse Oncopole Toulouse France

Karolinska University Hospital and Institute Stockholm Sweden

Russian Medical Academy for Postgraduate Education Moscow Russian Federation

University of Minnesota Hennepin County Medical Center Minneapolis USA

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