A person with chronic lymphocytic leukemia (CLL) may be unfit for intensive chemotherapy.
Problematic situations where more aggressive and toxic therapy may be needed:
(1) refractory CLL
(2) relapsing CLL
Conditions that may make a patient unable to tolerate intensive chemotherapy:
(1) older age (>= 70 years) with limited functional reserve
(2) frailty
(3) comorbid conditions affecting the heart, kidneys, bone marrow and other organs
Severe adverse reactions from previous chemotherapy may also serve as a warning.
Toxicities of import:
(1) bone marrow suppression with neutropenia and/or thrombocytopenia
(2) encephalopathy or other neurologic toxicity
Methods that can be used on patient unable to tolerate intensive chemotherapy:
(1) reduction in chemotherapy dose
(2) administration of hematopoietic growth factors
(3) use of targeted immune therapy targeting B-cells
