P106 | ONCOGERIATRIC ASSESSMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS OVER 65 YEARS IN TARGET ERA. A MONOCENTRIC PILOT STUDY AT FONDAZIONE POLICLINICO A. GEMELLI, ROME

Introduction: Chronic lymphocytic leukemia (CLL) primarily affects elderly adults. While targeted agents such as BTKi and BCL-2 inhibitors have improved outcomes, their use in elderly patients raises concerns regarding tolerance and toxicity, and there is still no established method for defining fitness in this context. A geriatric assessment may help tailor treatment by identifying vulnerable individuals. Methods: We conducted a pilot observational study at Fondazione Policlinico A. Gemelli (FPG), from June 2023 to March 2025, involving CLL patients over 65 years old, treated with BTKi and/or BCL-2 inhibitors alone or with anti-CD20 monoclonal antibody. A multidimensional geriatric assessment, utilizing validated oncogeriatric tools, was applied, including CLL-CI, Chair Stand Test (CST), polypharmacy (> 5 active principles), Mini-Cog test, and caregiver support. A score was given for each tool. The primary endpoint assessed the association between the score, based on these 5 items, and treatment-related toxicities (grade ≥2 per CTCAE v5.0). The secondary endpoint evaluated whether any of the 5 items had a stronger association with toxicity and if the score changed when reassessed after 6 months. Results: Thirty-nine CLL patients were enrolled (28 males and 11 females), with a median age of 75 years. Thirty-two patients started therapy (21 treatment naïve and 11 relapsed/refractory). Treatments included ibrutinib (6), acalabrutinib (13), zanubrutinib (5), venetoclax (4), venetoclax - obinutuzumab (2), and venetoclax - rituximab (2). Males had higher CIRS-G scores (p=0.046); CST was poorer in females (p=0.07 Figure 1). Ten patients discontinued treatment due to toxicity, and 4 required dose reductions. Patients needing treatment modifications had a higher median oncogeriatric assessment (3 vs 2). We re-evaluated 10 patients 6 months post-treatment: 3 improved, 3 remained stable, and 4 worsened. Discussion: Patients with reduced treatment tolerance had a higher median oncogeriatric score, showing a possible correlation between the assessment and treatment toxicity. CIRS-G and physical function appeared particularly relevant. Conclusion: Preliminary data from this pilot study support multidimensional geriatric assessment in elderly CLL patients, as it may be useful to identify patients at risk of toxicity and to personalize treatments. Larger studies are needed to confirm these findings and validate a score for assessing elderly patient fitness in this target era.