Factors influencing First-Line Treatment in CLL

Since 2011, the introduction of two new therapeutic classes has significantly improved the prognosis of patients undergoing treatment for CCL. The targeted treatments have gradually replaced the previously standard immunotherapy, demonstrating in large randomized trials a benefit in progression-free survival and even overall survival in favor of targeted therapies. The choice of molecules is based on several criteria, including cytogenetic assessment and the search for TP53 abnormalities, which confer a poorer prognosis and favor the use of BTKi, along with the determination of IGHV mutational status. Secondly, patient-specific characteristics and medical history, considering medical background, previous treatments, and preferences regarding various administration modalities. The treatment algorithms from the French Cooperative group FILO, updated in March 2023, reflect these selection criteria.