Contraceptives in chronic lymphocytic leukemia (CLL): a narrative review.

Women with chronic lymphocytic leukemia (CLL) face unique challenges when it comes to contraception. CLL predominantly affects older adults, with an age-adjusted incidence of approximately 4.7 new cases per 100,000 people per year and a median age at diagnosis of 70 years (Hallek and Al-Sawaf Am J Hematol 96(12):1679–1705, 2021). Although only about 9% of patients are diagnosed before age of 45, those who are of reproductive potential must carefully balance cancer treatment, fertility preservation, and effective contraception. In contemporary practice, most patients are treated with continuous Bruton’s tyrosine kinase (BTK) inhibitors or fixed-duration BCL2 inhibitor–based regimens, while chemoimmunotherapy is reserved for selected cases. These targeted approaches have variable profiles of cytopenias, bleeding and drug–drug interactions and can compromise ovarian reserve and carry teratogenic risks. This necessitates the need for tailored contraceptive counseling within a multidisciplinary oncofertility framework (Oktay et al J Clin Oncol 36(19):1994–2001, 2018).