Consensus guidelines for the management of treatment-naïve chronic lymphocytic leukaemia in Singapore (2024).
10.47102/annals-acadmedsg.2024174
- Author:
Yeow Tee GOH
1
;
Yvonne LOH
2
;
Esther CHAN
3
;
Yuh Shan LEE
4
;
Venkata Sreekanth SAMPATH
5
;
Daryl TAN
6
;
Shin Yeu ONG
1
;
Chandramouli NAGARAJAN
1
Author Information
1. Department of Haematology, Singapore General Hospital, Singapore.
2. Curie Oncology, Singapore.
3. Division of Haematology, Department of Haematology-Oncology, National University Hospital, Singapore.
4. Parkway Cancer Centre, Singapore.
5. Department of Haematology, Tan Tock Seng Hospital, Singapore.
6. Dr Daryl Tan Clinic for Lymphoma, Myeloma and Blood Disorders, Singapore.
- Publication Type:Practice Guideline
- Keywords:
BTKi;
chronic lymphocytic leukaemia;
management;
treatment algorithm;
treatment-naïve
- MeSH:
Humans;
Consensus;
Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis*;
Singapore
- From:Annals of the Academy of Medicine, Singapore
2024;54(1):36-52
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Chronic lymphocytic leukaemia (CLL) has a heterogeneous disease course and a variable preva-lence across populations. Appropriate management for achieving optimal outcomes requires consideration of multiple factors, including disease-related factors like genomic alterations, patient characteristics and fitness, availability and access to treatments, and logistics/cost. This review aims to provide comprehen-sive and pragmatic recommendations for the management of treatment-naïve (TN) CLL that are relevant to Singapore's clinical context.
METHOD:Clinical consensus statements were developed by an expert panel of haematologists from Singapore through a 2-round modified Delphi process. Statements were drafted using recent evidence-based guidelines and published literature. Panel members reviewed draft statements, provided anonymised feedback and proposed modifications where relevant. A physical meeting was held to facilitate discussion, voting and endorsement of the final consensus statements.
RESULTS:The final consensus included 15 statements covering major TN CLL patient subsets. The recommendations highlight the importance of molecular testing for key biomarkers, where available/accessible, to guide initial therapy. Due to the superior efficacy of targeted agents (Bruton's tyrosine kinase inhibitors [BTKis] and B-cell lymphoma 2 inhibitors [BCL2is]) these are favoured over standard chemotherapy or chemotherapy-immunotherapy, especially for patients with del(17p) or TP53 mutation, and less fit patients.
CONCLUSION:These consensus statements provide practical recommendations for the current manage-ment of TN CLL patients in Singapore and similar healthcare systems based on up-to-date evidence. Regular updates to treatment guidelines are important to ensure responsiveness to emerging evidence and evolving clinical practices and to improve patient outcomes and quality of life.
