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Background and objective The broad therapeutic arsenal and the biological heterogeneity of patients with chronic lymphocytic leukemia (CLL) makes it difficult to standardize treatment for CLL patients with specific clinical settings in routine clinical practice. These considerations prompted us to elaborate the present consensus document, which constitutes an update of the previous version published in 2013, mainly focusing on novel treatment strategies that have been developed over last 5 years, namely B-cell receptor inhibitors (ibrutinib and idelalisib), anti-CD20 monoclonal antibodies (ofatumumab and obinutuzumab), and Bcl-2 inhibitors (venetoclax). Material and methods A group of experts from the Spanish Chronic Lymphocytic Leukemia Group reviewed all published literature from January 2010 to January 2016, in order to provide recommendations based on clinical evidence. For those areas without strong scientific evidence, the panel of experts established consensus criteria based on their clinical experience. Results The project has resulted in several practical recommendations that will facilitate the diagnosis, treatment, and follow-up of patients with CLL. Conclusions There are many controversial issues in the management of CLL with no appropriate studies for making consensus recommendations.

This study was supported by research funding from (Spanish Ministry of Science and Innovation MICINN) through the Instituto de Salud Carlos III (ISCIII) and Red Temática de Investigación del Cáncer (RTICC) (RD06-0020-0039 to E Campo and RD06-0020-0051 to AL-G), Fondo de investigaciones sanitarias (PI07/0301, MA) and Botín Foundation (CL-O)., Villamor, N., Conde, L., Martínez-Trillos, A., Cazorla, M., Navarro, A., Beà, S., López, C., Colomer, D., Pinyol, M., Aymerich, M., Rozman, M., Abrisqueta, P., Baumann, T., Delgado, J., Giné, E., González-Díaz, M., Hernández, J.M., Colado, E., Payer, A.R., Rayon, C., Navarro, B., JoséTerol, M., Bosch, F., Quesada, V., Puente, X.S., López-Otín, C., Jares, P., Pereira, A., Campo, E., López-Guillermo, A.

Chronic lymphocytic leukemia is the most common chronic lymphoproliferative disorder in Spain. The clinical management of this entity varies widely. Currently, in Spain, there are no national consensus guidelines, such as those published in other countries, to guide the diagnosis and treatment of this malignancy and the use of prognostic scores. This article reviews the current scientific literature and addresses issues on the diagnosis of chronic lymphocytic leukemia, the spread of the disease, the presence of comorbidities, the classification of prognostic scores, the common treatment regimens stratified by risk factors, and the management of complications associated with both the disease and its treatment, as well as the various controversies related to this entity. This document was drafted with the collaboration of national experts and aims to establish practical guidelines with their corresponding levels of evidence and grades of recommendation to guide the diagnosis, treatment and follow-up of patients with chronic lymphocytic leukemia.

Resumen La leucemia linfocitica cronica es el sindrome linfoproliferativo cronico mas frecuente en nuestro pais, existiendo una amplia heterogeneidad en su abordaje clinico. En la actualidad, en Espana no se dispone de guias de consenso nacionales similares a las publicadas en otros paises para su diagnostico, clasificacion pronostica y tratamiento. El presente trabajo revisa la evidencia cientifica actual y aborda cuestiones relacionadas con el diagnostico, el estudio de extension, la presencia de comorbilidades y la clasificacion de escalas pronosticas, los esquemas de tratamiento habituales estratificados por grupos de riesgo, el tratamiento de las complicaciones asociadas tanto a la enfermedad como a los procedimientos, asi como diferentes controversias que rodean a la enfermedad y su tratamiento. El documento, realizado con la colaboracion de expertos nacionales, permite establecer unas recomendaciones de caracter practico, con su correspondiente nivel de evidencia y grado de recomendacion, que facilitaran el diagnostico, tratamiento y seguimiento de los pacientes con leucemia linfocitica cronica.