iwCLL 2025 | Selecting therapy for patients with CLL: navigating the gap between guidelines and clinical practice

Usually the clinicians tend to use in their clinical practice guidelines. Guidelines are regularly updated, but probably guidelines are not able to capture some characteristics of patients. In other words, they are unable to capture the logistics of patients. They are unable to capture the fact that the patient is able to be supported by a caregiver. Also, specific comorbidities are not specifically analyzed in the guidelines. So at the end, there is the need to bridge a gap between the guidelines and clinical practice. 

So looking at the therapy, we try to identify four different categories. The first categories are therapies that are really highly recommended. So the therapies that are recommended, the therapies that are feasible, and finally the therapies that are not recommended. What does it mean? It means that this type of categorization was done using all different components that can be used for choosing a therapy, not only the characteristic of the disease and comparison of patients, but also logistics and what is the support of the patient and importantly what is the life expectancy of the patient because probably the choice can be modulated also according to this point. 

There is an important point finally that we need, obviously what you have proposed is just a proposal, so it is able to generate some hypothesis, but it is important also that guidelines can be informed by what is the patient preference and I think that we need to get more information about studies based on discrete choice experiments.

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