# Fitness in CLL

## TL;DR

This paper discusses how the concept of patient fitness in chronic lymphocytic leukemia (CLL) should be updated to include factors like biological age and frailty, beyond traditional measures.

## Contribution

The paper redefines fitness in CLL management to include biological age, comorbidities, and frailty in the context of modern therapies.

## Key findings

- Fitness in CLL now includes biological age, comorbidities, and frailty.
- Physical activity and nutrition are emphasized for maintaining patient health.
- Current treatment changes require updated fitness evaluation methods.

## Abstract

Treating CLL has become more complex because of new targeted therapies. As a result, the idea of “fitness” needs to be redefined. In the past, fitness mainly meant whether a patient could tolerate chemotherapy and immunotherapy. Today, fitness also considers biological age, comorbidities, polypharmacy and overall frailty. These factors are especially important as treatments continue to change and as we better understand older patients with CLL. Therefore, more attention should be given to maintaining a patient’s overall health, including physical activity and nutrition. This review examines these topics in detail and aims to clarify how fitness should be evaluated and updated in current clinical practice.

The increased complexity of CLL management, driven by the advent of targeted therapies, makes it necessary to redefine the concept of fitness, which until a few years ago was limited to the patient’s ability to undergo chemoimmunotherapy. In the current therapeutic landscape, fitness assessment must also consider biological age, comorbidities, and frailty, which have become increasingly relevant due to evolving treatment options and a more nuanced understanding of the elderly CLL population. In this context, the general condition of the patient should be preserved with greater attention to physical activity and nutrition. This narrative review analyzed in depth all these aspects with the aim of providing insights into fitness assessments and their actualization.