iwCLL 2025 | Optimizing CLL care: the impact of comedications and lifestyle on patient outcomes and QoL

So we have come a long way in understanding the biology of CLL and evolving the treatment using now only targeted therapy instead of chemoimmunotherapy. Yet the majority of our patients, after being diagnose,d are being told that they do not need treatment and they are going only to be wait and watch. And they ask us what can we do to be proactive and to control our disease better. So I’m going to discuss several topics. 

One is we have looked at the drugs that patients are taking not for the CLL but for their chronic comorbidities. And we ask whether they are just a demonstration of the comorbidities or do they really affect also the CLL course. So we identified the most frequent drugs that patients are taking for chronic diseases, such as cardiovascular disease, pulmonary disease, gastric disease, etc. And we went systematically, drug by drug, and we looked at a cohort of patients of about 3,500 patients who are only in wait and watch, and we looked whether a certain class of drug has an impact on the CLL course, meaning that the patient that is taking it has a shorter time to first treatment. And we raised three red flags, meaning that three groups of drugs impact the course of the disease negatively, and one green flag, which means one group of drugs impact positively the time to next treatment. 

So we identified that patients are taking very easily the proton pump inhibitors, PPIs, and these were already associated with increased mortality in hematological malignancy, but now we demonstrated that it’s also associated with a shortened time to first treatment. Similar results we have also in the group of using benzodiazepines. A lot of patients after diagnosis are getting anxiety or depression, and it’s very easily prescribed. And the third group of drugs are the beta blockers that are being used mainly for cardiac diseases. On the other side, we identified that the use of vitamin D supplements has a protective effect and prolongs the time to first treatment or treatment-free survival. So this is the first part of my talk and then I discuss also what do we know on diet, what do we know on sport or physical activity, and what do we know on quality of life of patients, and how can we impact that to be proactive and to be involved and control the disease progression. 

Well, you know, we have really few data regarding the diet and the physical activity. Probably it’s very difficult to design clinical trials in these terms. So most of the data we have is based on questionnaires. But there are some data, and now I see more and more prospective trials that examine whether a certain type of diet influences the development of CLL. So we know that Western diets impact negatively, if it’s a high-fat, high-sugar diet, for example. And for physical activity, now we see also some groups that are starting to do some interventional programs that affect also the quality of life and also the sensation of fatigue. So they have a positive impact, and they probably need to be applied in a larger cohort of patients.

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