Update on Therapy of Chronic Lymphocytic Leukemia

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BlankUpdate on Therapy of Chronic Lymphocytic Leukemia

1.. G. Gribben and

2.. O'Brien

+ Author Affiliations

1.. From the Barts Cancer Institute, Barts and The London School of Medicine,

Queen University of London, London, United Kingdom; and The University of

Texas MD Cancer Center, Houston, TX.

1.. Corresponding author: G. Gribben, MD, DSc, Barts Cancer Institute,

Barts and the London School of Medicine, Queen University of London,

Charterhouse Square, London EC1M 6BQ United Kingdom; e-mail:

j.gribben@....

Abstract

There have been tremendous advances in the treatment of chronic lymphocytic

leukemia (CLL) over the past decade, with the goal of therapy no longer being

just to palliate symptoms but now to achieve complete remission, eradicate

minimal residual disease, and improve survival. During this period, there have

also been major advances in identification of molecular factors associated with

increased risk of progression. The clinical utility of these factors is being

explored to determine whether we can identify groups of patients who should be

treated earlier in their disease course and whether we can tailor therapy for

groups of patients with specific molecular markers of disease. First-line

chemoimmunotherapy approaches now offer prolonged survival, and there is a need

to identify patients who are suitable candidates for allogeneic stem-cell

transplantation that uses reduced-intensity conditioning regimens. The vast

majority of CLL patients are either too old or do not have sufficiently

high-risk disease to warrant these approaches, and effective therapies that can

be tolerated by the more frail elderly patients with this disease are urgently

needed. Numerous novel agents are being developed, and their role in the

first-line treatment of frail patients or those who relapse after previous

treatment is being explored in clinical trials.