Chronic Lymphocytic Leukemia: Diagnosis and Treatment

August 24, 2006

Education and Research

KAREN W.L. YEE, MD; SUSAN M. O’BRIEN, MD

Address correspondence to M. O’Brien, MD, Department of Leukemia,

University of Texas M. D. Cancer Center, 1515 Holcombe Blvd, Box 428,

Houston, TX 77030 (e-mail: sobrien@...). Individual reprints of this

article and a bound booklet of the entire Symposium on Oncology Practice:

Hematological Malignancies will be available for purchase from our Web site

Traditionally, the goal of therapy in chronic lymphocytic leukemia (CLL) has

been palliative, with first-line therapy using alkylating agents and/or involved

field radiotherapy (depending on the stage of disease and sites of involvement)

because of the older age of affected patients and the low rate of complete

remissions (CRs) with no improvement in overall survival despite treatment. With

increasing knowledge about the biology, molecular genetics, and prognostic

factors of the disease, the philosophy of care for patients with CLL has evolved

from palliation to aiming for a potential cure, especially in younger patients.

Furthermore, multiple treatment options have emerged, including purine

analogues, monoclonal antibodies, and potentially stem cell transplantation.

These have been associated with higher frequencies of CRs and longer durations

of responses compared to conventional chemotherapy. In addition, a subset of

patients treated with chemoimmunotherapy can achieve durable CRs and molecular

remissions. This may translate into improved disease-free survival and

potentially a “cure.” Because of the heterogeneous nature of CLL, new prognostic

markers are currently being incorporated into clinical trials to determine their

role in routine clinical practice. This review summarizes current therapeutic

regimens that are being evaluated in patients with CLL and management of

disease-related complications.

Mayo Clin Proc. 2006;81(8):1105-1129

PMID: 16901035

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