This paper outlines the updated guidelines for the treatment of chronic lymphocytic leukaemia, with an emphasis on prehabilitiation and optimising general well-being. Licensed treatments for CLL in 2025 include inhibitors of B-cell lymphoma-2, BCL2i (venetoclax), covalent inhibitors of Bruton tyrosine kinase, cBTKi (ibrutinib, acalabrutinib and zanubrutinib) used as monotherapy or in combination with anti-CD20 monoclonal antibodies (rituximab and, in first line only, obinutuzumab), and the first non-covalent BTKi (pirtobrutinib). Treatment regimens are either continuous (given until intolerance or progression) or fixed duration and the choice should be guided by whether fixed duration or continuous treatment is preferred. These targeted agents have superseded chemoimmunotherapy, which is no longer recommended except where targeted agents are unavailable or contraindicated.
Declaration of Interests
The BSH paid the expenses incurred during the writing of this Guideline. All authors have made a declaration of interests to the BSH and Task Force Chairs which may be viewed on request.