Clinical relevance and treatment of nonautoimmune anemia in chronic lymphocytic leukemia

Anemia has an unfavorable impact on quality of life in chronic lymphocytic leukemia (CLL), increases the likelihood of receiving blood transfusions, and eventually has a negative impact on overall survival. Although discrepancies in perception of health-related quality of life between doctors and patients lead to the undertreatment of anemia, CLL patients undergoing chemotherapy who have a hemoglobin level <10 g/dL should be considered for treatment with erythropoiesis-stimulating agents. For hemoglobin values of 10-12 g/dL, the role of performance status and comorbidities should not be underestimated. In this setting, the evaluation of physical fitness using the Cumulative Illness Rating Scale should help physicians to identify those patients with hemoglobin levels of 10-12 g/dL who are suitable for therapy with erythropoiesis-stimulating agents. Finally, the increasing use of aggressive approaches to therapy should encourage physicians towards appropriate management of chemotherapy-induced anemia in CLL patients.