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Chronische lymphatische Leukämie beim alten und geriatrischen Patienten

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Geriatrische Onkologie

Part of the book series: Springer Reference Medizin ((SRM))

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Zusammenfassung

Betroffene mit CLL sind häufig alt. Bei Vorliegen einer Behandlungspflichtigkeit sollte im Rahmen der Therapieplanung neben der molekularen Charakterisierung der CLL (17p-Deletion und TP53-Mutation) auch die gesundheitliche Fitness des Betroffenen sorgfältig beurteilt werden. Neben einer umfassenden Anamnese und körperlichen Untersuchung sind dabei Komorbiditäts-Scores und geriatrische Assessments informativ. Therapiestandard für die unvorbehandelte CLL ohne 17p-Deletion bzw. TP53-Mutation ist bei älteren Patienten die Immunchemotherapie, wobei sich die Auswahl der Chemokomponente (Fludarabin, Bendamustin, Chlorambucil) und des Antikörpers (Rituximab, Ofatumumab, Obinutuzumab) nach der gesundheitlichen Fitness richtet. Die unvorbehandelte CLL mit 17p-Deletion oder TP53-Mutation wird bevorzugt mit dem Kinaseinhibitor Ibrutinib behandelt. Ältere Patienten mit Frührezidiv erhalten Ibrutinib, Idelalisib plus Rituximab oder Venetoclax. Spätrezidive können erneut immunchemotherapiert werden.

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  1. Klinik I für Innere Medizin, Uniklinik Köln, Sektion für Onkologische Geriatrie, Klinik für Geriatrie, St. Marien-Hospital, 50937, Köln, Deutschland

    Valentin Goede

  2. Klinik I für Innere Medizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    Michael Hallek & Barbara Eichhorst

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  1. Valentin Goede
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  2. Michael Hallek
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Correspondence to Valentin Goede .

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Editors and Affiliations

  1. II. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany

    Matthias Ebert

  2. II. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany

    Nicolai Härtel

  3. Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Thüringen, Germany

    Ulrich Wedding

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  1. Abteilung für Palliativmedizin, Universitätsklinikum Jena, Klinik für Innere Medizin II, Erlanger Allee 101, 07747, Jena, Deutschland

    Ulrich Wedding

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Goede, V., Hallek, M., Eichhorst, B. (2017). Chronische lymphatische Leukämie beim alten und geriatrischen Patienten. In: Ebert, M., Härtel, N., Wedding, U. (eds) Geriatrische Onkologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49083-9_19-1

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