Treatment of B-cell chronic lymphocytic leukemia with nonchemotherapeutic agents: experience with single-agent and combination therapy.

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Treatment of B-cell chronic lymphocytic leukemia with nonchemotherapeutic

agents: experience with single-agent and combination therapy.

S Faderl, A Ferrajoli, O furt, and A Pettitt

Leukemia, November 6, 2008;

1Department of Leukemia, M.D. Cancer Center, The University of Texas,

Houston, TX, USA.

Recent advances in purine analog-based combination chemotherapy and

chemoimmunotherapy have significantly improved response rates and

progression-free survival in patients with B-cell chronic lymphocytic leukemia

(CLL). However, there are clinical scenarios in which purine analog-based

treatment may not be appropriate, either because of the risk of toxicity in

patients with comorbidity or because purine analog-based therapies are unlikely

to achieve satisfactory responses. Novel, nonchemotherapeutic treatment regimens

are becoming increasingly important in these patients, as well as in patients in

whom combination chemotherapy-based treatment has failed or resulted in relapse.

Nonchemotherapeutic agents include monoclonal antibodies, glucocorticoids,

immunomodulatory drugs, drugs with specific intracellular molecular targets,

vaccines and cellular immunotherapies. These agents use diverse mechanisms of

action that may complement each other, therefore providing a scientific

rationale to investigate combinations of these agents in the treatment of CLL.

In this review, we will discuss current knowledge of available

nonchemotherapeutic agents, available clinical experience with their use alone

and in combination and how these approaches may affect outcomes in patients with

CLL.Leukemia advance online publication, 6 November 2008;

doi:10.1038/leu.2008.322.

PMID: 18987653