{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:45:05Z","timestamp":1791229505971,"version":"4.1.0"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The therapeutic landscape of chronic lymphocytic leukemia (CLL) has been profoundly transformed by the introduction of Bruton tyrosine kinase and BCL\u20102 inhibitors. Despite improved survival outcomes, treatment selection remains complex, particularly in older patients with comorbidities, frailty, and increased infectious vulnerability. To address areas of clinical heterogeneity and support real\u2010world decision\u2010making, a two\u2010round Delphi consensus process was conducted among 15 hematologists from 15 hematology departments across two Italian regions, Calabria and Sicily. A steering committee developed 12 statements covering key clinical and organizational aspects of CLL management, including infectious risk assessment, frailty evaluation, and the role of TP53 alterations in therapeutic choice. Agreement was assessed using a four\u2010point Likert scale, with consensus predefined as \u2265\u200970% agreement or disagreement. All invited clinicians participated in both rounds (100% response rate). In the first round, consensus was achieved for 8 of 12 statements (66.7%). Following reformulation of unresolved items, two additional statements reached consensus in the second round. Overall, strong agreement was observed for five statements, while moderate convergence persisted for others. Panelists emphasized that infectious risk assessment should systematically inform treatment decisions and that structured frailty tools, including ECOG Performance Status and the Clinical Frailty Scale, may improve patient stratification. Although TP53 alterations were recognized as critical biological determinants, therapeutic decisions in older patients should balance genetic risk with age, comorbidities, frailty, and socioeconomic context. This regional initiative highlights priorities for patient\u2010centered, multidimensional CLL management and may inform the development of optimized care pathways within coordinated regional networks.<\/jats:p>","DOI":"10.1111\/ejh.70202","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:45:29Z","timestamp":1777009529000},"page":"442-447","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Regional Standardization of\n                    <scp>CLL<\/scp>\n                    Management: Results of a Delphi Consensus Process"],"prefix":"10.1111","volume":"117","author":[{"given":"Enrica Antonia","family":"Martino","sequence":"first","affiliation":[{"name":"Hematology Unit, Department of Onco\u2010Hematology, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Chiarenza","sequence":"additional","affiliation":[{"name":"Division of Hematology A.O.U. Policlinico \u201cG. Rodolico\u2010S. Marco\u201d  Catania Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatrice","family":"Mancuso","sequence":"additional","affiliation":[{"name":"Haematology, Biomedical Department of Internal Medicine and Medical Specialties University of Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Rossi","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2010Oncology Azienda Universitaria Ospedaliera Renato Dulbecco  Catanzaro Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Stelitano","sequence":"additional","affiliation":[{"name":"G.O.M. Bianchi Melacrino Morelli, Reggio Calabria  Reggio Calabria Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignazio","family":"Abbene","sequence":"additional","affiliation":[{"name":"Onco\u2010Hematologia and BMT Unit, Dipartimento Oncologico \u201cLa Maddalena\u201d, Palermo  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Cabibbo","sequence":"additional","affiliation":[{"name":"Ospedale \u201cGiovanni Paolo II\u201d\u2010UOSD Ematologia, Ragusa  Ragusa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Caracciolo","sequence":"additional","affiliation":[{"name":"University Magna Graecia of Catanzaro  Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Cotzia","sequence":"additional","affiliation":[{"name":"Section of Hematology, Ospedale \u201cUmberto I\u201d  Siracusa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia","family":"Figuera","sequence":"additional","affiliation":[{"name":"Division of Hematology A.O.U. 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Garibaldi  Catania Catania Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciano","family":"Levato","sequence":"additional","affiliation":[{"name":"Department of Hematology\u2010Oncology Azienda Universitaria Ospedaliera Renato Dulbecco  Catanzaro Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Marino","sequence":"additional","affiliation":[{"name":"Ematologia Ospedale Vittorio Emanuele \u2013 Castelvetrano (TP)  Castelvetrano (TP) Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Mineo","sequence":"additional","affiliation":[{"name":"Division of Hematology Ospedale \u201cSan Vincenzo\u201d  Taormina Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Nocilli","sequence":"additional","affiliation":[{"name":"Division of Hematology Azienda Ospedaliera Papardo  Messina Messina Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppa","family":"Penna","sequence":"additional","affiliation":[{"name":"Division of Hematology A.O.U. 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