Table 2. Current treatment recommendations for chronic lymphocytic leukemia (CLL)*¹.

Binet stage	Fitness*2	Genetic TP53 changes	First-line treatment
A/B without symptoms	irrelevant	Irrelevant	None
C, A/B with symptoms	“go go“	No	FCR (BR ≥ 65 years)
		Yes	Ibrutinib, if contraindications for ibrutinib: venetoclax, idelalisib + R, (allo-HSCTx)
	“slow go“	Yes
		No	Chlorambucil + obinutuzumab or ibrutinib
Binet stage	Fitness*2	Genetic TP53 changes	Relapse treatment
Early (<3 years)	“go go“	Irrelevant	Ibrutinib, idelalisib + R, venetoclax*3, alemtuzumab, where appropriate, discuss allo-HSCTx as consolidation
	“slow go“		Ibrutinib, idelalisib + R, venetoclax*3, alemtuzumab, BR/BO, Ofatumumab mono, HD rituximab, lenalidomide (+ R)
Late (>3 years)	Irrelevant	Yes	Ibrutinib, idelalisib + R, venetoclax*3, alemtuzumab, where appropriate, discuss allo-HSCTx as consolidation
	“go go“	No	Repeat first-line treatment
	“slow go“

*¹ Modified according to the AWMF Clinical Practice (S3) Guideline for CLL and according to the Onkopedia guideline for CLL

*² Physical fitness was determined using the Comorbidity Illness Rating Scale (CIRS).

Patients with a score of or below 6 were labelled as “fit“ (or “go go“), patients with a score above 6 as “ unfit“ (or “ slow go“).

*³ In patients without del(17p) / TP53 mutations only after failure of chemotherapy and BCR inhibitor

FCR, fludarabine, cyclophosphamide plus Rituximab; BR, bendamustine plus rituximab; R, rituximab; allo-HSCTx, allogeneic hematopoietic stem cell transplantation; BO, bendamustine plus ofatumumab; HD, high dose.