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Highlights a venetoclax plus obinutuzumab (VenObi) report in Italy, noting feasibility in routine care, low toxicity-related discontinuation, limited differences by validated fitness scores, and associations with caregiver need and prolonged steroid pre-treatment. Argues for more individualized decision-making superseding simplistic age/fitness dichotomies.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/the-age-of-fit-equity-ignoring-age-and-fitness-in-treatment-selection-for-chronic-lymphocytic-leukemia-editorial/448192/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/the-age-of-fit-equity-ignoring-age-and-fitness-in-treatment-selection-for-chronic-lymphocytic-leukemia-editorial/448192.png","ImageObject",300,407,{"name":92,"@type":93},"Theodore","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What clinical-trial limitation does the editorial emphasize for CLL?","Question",{"text":112,"@type":113},"It stresses that many trials use strict inclusion and exclusion criteria, leading to patient selection that may not represent typical “normal” CLL patients in routine practice.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What did the real-world VenObi experience in Italy show regarding fitness scores?",{"text":117,"@type":113},"After assessing fitness with multiple scores, unfit patients did not have more treatment modifications or toxicity-related discontinuations than fit patients.",{"name":119,"@type":110,"acceptedAnswer":120},"Which non-traditional factors were associated with discontinuation for toxicity?",{"text":121,"@type":113},"The editorial highlights “caregiver need” and prolonged steroid pre-treatment as variables linked to toxicity-related discontinuation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},448192,1790785742,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},7971461740886,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","EDITORIAL  \nThe age offit-equity: ignoring age and fitness in treatment selection for chronic lymphocytic leukemia  \nCarolyn Owen  \nDivision of Hematology & Hematological Malignancies, University of Calgary, Arthur Child Comprehensive Cancer Centre, Calgary, Canada  \nCorrespondence: C. Owen  \n[Carolyn.owen@ahs.ca](Carolyn.owen@ahs.ca)  \nReceived: July 25, 2025.  \nAccepted: August 19, 2025.  \nEarly view: August 28, 2025.  \n[https://doi.org/10.3324/haematol.2025.288379](https://doi.org/10.3324/haematol.2025.288379)  \n©2026 Ferrata Storti Foundation  \nPublished under a CC BY-NC license   \nIn this issue of Haematologica, Frustaci and colleagues report on the outcomes of 271 patients with chronic lymphocytic leukemia (CLL) treated with venetoclax + obinutuzumab (VenObi) during the first year of availability of this therapy in Italy 1 In this real-world report, the authors document the feasibility of delivering VenObi in routine clinical practice and highlight some non-traditional factors that may be appropriate to consider when selecting this or other first-line therapy for CLL. They noted that most patients completed the first two cycles of therapy, including the obinutuzumab loading doses and the venetoclax ramp-up (the ‘debulking phase’), and that treatment discontinuation for toxicity was infrequent at only 11% . Despite assessing fitness by several different scores, unfit patients did not have more treatment modifications or discontinuations than fit patients. Instead, the authors’ noted an impact of‘caregiver need’ and prolonged steroid pre-treatment as variables associated with discontinuation for toxicity. Hematologists and oncologists are recognized for their pursuit of ‘evidence-based medicine’ with treatment recommendations typically strongly based on well-performed randomized phase III clinical trials. Such trials have been performed with VenObi in CLL in two frontline clinical trials.2,3 This requirement is important to ensure that the most effective and safe therapies are recommended for our patients. However, most clinical trials have strict inclusion/ exclusion criteria and this can lead to patient selection that is not always representative of “normal” patients with the disease of interest. This problem of clinical trial generalizabilty and the desire to ensure more representative and inclusive approaches to clinical trial enrollment is now well recognized.4  \nHistorically, CLL clinical trials were particularly noted to include patient populations that were not representative. CLL is a disease of older people and, as such, the majority of patients who require therapy for CLL have comorbidities with or without organ compromise that may influence their ability to tolerate traditional chemo-immunotherapies and  \nthat previously rendered them ineligible for many clinical trials. This was best exemplified by the German CLL Study Group (GCLLSG) CLL8 clinical trial that was widely hailed as transformative in the treatment of CLL by being the first study to demonstrate an overall survival advantage in previously untreated CLL patients when rituximab was added to fludarabine and cyclophosphamide (FCR) .5 The CLL8 study should have rendered FCR the standard of care for CLL but this was not possible because it was far too intensive for the “average” CLL patient. While the median age at diagnosis for CLL is 72 years, the median age in the CLL8 study was 61 years such that only a minority of CLL patients were eligible for treatment with FCR. The GCLLSG and others quickly recognized that the best therapy was not yet clearly defined for most CLL patients and this began an era of CLL clinical trials targeted at a population of patients with advanced age and/or comorbidities. Simultaneously, trials were performed with FCRas the comparator to improve upon therapeutic options in young/fit CLL patients. Thus, over time, we have come to a situation in CLL whereby clinical trials are dichotomized to those targeting young and/or fit pati","cbCaijvAdrASysDx","https://ap.wps.com/l/cbCaijvAdrASysDx","pdf",91527,"English","# Editorial overview\n## Real-world VenObi outcomes and feasibility\n## Limits of fitness scoring and clinical-trial generalizability\n## Historical trial age/fitness dichotomies in CLL\n## Implications for individualized treatment decisions","[{\"question\":\"What clinical-trial limitation does the editorial emphasize for CLL?\",\"answer\":\"It stresses that many trials use strict inclusion and exclusion criteria, leading to patient selection that may not represent typical “normal” CLL patients in routine practice.\"},{\"question\":\"What did the real-world VenObi experience in Italy show regarding fitness scores?\",\"answer\":\"After assessing fitness with multiple scores, unfit patients did not have more treatment modifications or toxicity-related discontinuations than fit patients.\"},{\"question\":\"Which non-traditional factors were associated with discontinuation for toxicity?\",\"answer\":\"The editorial highlights “caregiver need” and prolonged steroid pre-treatment as variables linked to toxicity-related discontinuation.\"}]","The age of fit-equity: ignoring age and fitness in treatment selection for chronic lymphocytic leukemia - Editorial | PDF",1790725944]