Chronic lymphocytic leukemia (CLL) treatment has undergone a significant evolution with a shift from historical chemotherapeutic regimens to targeted therapies such as Bruton tyrosine kinase (BTK) and BCL-2 inhibitors. These advancements have been associated with a notable improvement in survival rates with a transformation of CLL into a chronic and manageable condition for most persons with this disease. However, as a consequence of improved outcomes, long-term CLL survivors now face emergent challenges which include a risk of infections, cardiovascular complications, and secondary malignancies. In this changed scenario, holistic models of care are essential to address emergent health risks. Such models of care for CLL patients require a multidisciplinary approach that integrates CLL treatment with the proactive management of frailty, comorbidities, and psychosocial well-being to enhance both survival and quality of life (QoL). CLL predominantly affects older persons, many of whom present with concurrent frailty and comorbidities that may complicate CLL treatment and impact QoL. Comprehensive geriatric assessments (GA) may play a critical role in the identification of persons at a heightened risk of treatment-related toxicity and may help guide rational therapy selection, particularly in very frail persons. In addition to the assessment of hematological responses, the prospective assessment of patient-reported outcomes (PROs) and frailty metrics may offer a more nuanced understanding of the global treatment benefits. A survivorship-focused care model is crucial to address the multifaceted needs of CLL patients with the extension of patient care into the broader domain of long-term health maintenance with associated improvements in QoL.
慢性淋巴细胞白血病（CLL）的治疗经历了显著演变，从传统的化疗方案转向以布鲁顿酪氨酸激酶（BTK）抑制剂和BCL-2抑制剂为代表的靶向治疗。这些进展显著提高了患者生存率，使CLL对多数患者而言转变为一种可长期控制的慢性疾病。然而，随着治疗效果的改善，长期生存的CLL患者面临新的挑战，包括感染风险、心血管并发症及继发性恶性肿瘤。在此新形势下，需要建立整体性照护模式以应对新兴健康风险。针对CLL患者的照护模式应采用多学科协作方法，将CLL治疗与衰弱状态、合并症及心理社会健康的主动管理相结合，从而提升生存率与生活质量。 CLL主要影响老年人群，其中许多患者伴有衰弱和合并症，可能使CLL治疗复杂化并影响生活质量。综合老年评估在识别治疗相关毒性高风险人群方面具有关键作用，有助于指导合理治疗方案选择，尤其对于重度衰弱患者。除评估血液学反应外，前瞻性评估患者报告结局和衰弱指标，可更精准把握整体治疗获益。建立以生存管理为核心的照护模式至关重要，该模式将患者照护延伸至长期健康维护的广阔领域，通过满足CLL患者的多维度需求，最终实现生活质量的全面提升。
Chronic Lymphocytic Leukemia Care and Beyond: Navigating the Needs of Long-Term Survivors
肿瘤(癌症)患者之家