Leukemia Research 125(2023)107016Contents lists available at ScienceDirectLeukemia ResearchELSEVIERjournal homepage:www.elsevier.com/locate/leukresCanadian evidence-based guideline for frontline treatment of chroniclymphocytic leukemia:2022 updateCarolyn Owen,Versha Banerji,Nathalie Johnson,Alina Gerrie,Andrew Aw,Christine Chen,Sue RobinsonDivision of Hematology and Henatological Malignancies,Foothills Medical Centre,Calgary,AB T2N 4N2,CanodaDepartment of Hematology and Medical Oncology,CancerCare Manitoba Winnipeg,MB R3E OV9,CanodaDeparmnent of Medicine,Jewish General Hospital,MontreaL QC H3T 1E2,CanodaDivision of Medical Oncology,Centre for Lymphoid Cancer,BC Cancer,Vancouver,BC V5Z 4E6,Conada'Division of Hematology,The Ouawa Hospital,Ouawa,Ontaro KIY 4E9,CanodaDeparment of Medical Oncology,University of Torono,and Princess Margre Cancer Centre,Toronto ON M5G 2C1,Canodas Division of Hematology,Dalhousie University,and qeli Health Sclences Centre Halyfax NS B3H 2Y9,CanadaARTICLE INFOABSTRACTKeywordsChronic lymphocytic leukemia (cu)is the most common adult leukemia in North America.In 2018,the firstChronic lymphocytic leukemiaunified national guideline in Canada was developed for the front-line treatment of cu.that helped guide treat-ament across the country.As an update in 2022,a group of cinical experts from across Canada came together toFrontlineprovide input and guidance that included new and innovative treatments and approaches that will continue toTreatmentPrognosisprovide health care professionals with clear guidance on the first-line management of aL.Recommendations时teswere provided in consensus based on available evidence for the first-line treatment of cu.1.Introductioninhibitors have proven particularly active in CLL,including inhibitors ofBruton tyrosine kinase (BTK)(i.e.ibrutinib (IBR),acalabrutinib (ACAL)Chronic lymphocytic leukemia (CLL)is the most common lympho-zanubrutinib (ZANU)),apoptosis regulator B-cell leukemia/lymphomaproliferative disorder in adults in Canada,with over 2000 patients2 (BCL-2)inhibitor li.e.venetoclax (V)],and phosphatidylinositol 4,diagnosed per year and resulting in more than 600 deaths annually [1.5-bisphosphate 3-kinase catalytic subunit delta (PI3K6)inhibitor (i.e.2].Most CLL patients are elderly,with a median age of 72 years atidelalisib).Emerging CLL therapies include doublet and triplet combi-diagnosis;often these patients present with a number of comorbiditiesnations of novel agents,bi-specific antibodies,non-covalent BTK in-that increase the risk of morbidity and mortality from therapy [2].Ashibitors and cellular therapies [6-8].With advancements in treatments,CLL is a clonally complex disease,the genetic and molecular charac-the 5-year overall survival (OS)of patients with CLL has steadilyteristics of the CLL cells play a paramount role in deciding treatmentimproved over time [9].approaches to achieve the best outcomes for patients.The 2018 Canadian clinician consensus guideline on first-line trea
