Diagnosis and treatment of chronic lymphocytic leukemia: 2025 recommendations of the Brazilian Group of Chronic Lymphocytic Leukemia of the Brazilian Association of Hematology and Hemotherapy (ABHH)

IF 1.8 Q3 HEMATOLOGY

Hematology, Transfusion and Cell Therapy Pub Date : 2025-04-01 DOI:10.1016/j.htct.2025.103822

Carlos Sérgio Chiattone , Fernanda de Morais Marques , Valeria Buccheri , Mihoko Yamamoto , Sergio Costa Fortier , Maura Rosane Valerio Ikoma-Colturato , Nelson Hamerschlak , Vera Lucia de Piratininga Figueiredo , Talita Maira Bueno da Silveira , Abel Costa , Dani Laks , Rony Schaffel , Wolney Gois Barreto , Adriana Scheliga , Pedro Amoedo Fernandes , Samir Kanaan Nabhan , Rafael Dezen Gaiolla , Matheus Vescovi Gonçalves , Danielle Leão Cordeiro de Farias , Glaciano Ribeiro , Celso Arrais-Rodrigues

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Abstract

Chronic lymphocytic leukemia, characterized by an accumulation of monoclonal B lymphocytes, is the most common adult leukemia. The disease predominantly affects older adults, with a significant proportion being asymptomatic at diagnosis. This manuscript provides a comprehensive review of chronic lymphocytic leukemia, including its epidemiology, clinical presentation, diagnostic criteria, and treatment strategies. Prognostic factors, particularly IGHV mutation status and chromosomal abnormalities, are discussed as critical determinants of disease behavior and treatment response. Recent advances in targeted therapies, such as Bruton's tyrosine kinase inhibitors (BTKi) and B-cell lymphoma 2 inhibitors (BCL-2i), have changed the treatment landscape by demonstrating superior efficacy to chemoimmunotherapy. However, disparities in access to care, particularly in low- and middle-income countries such as Brazil, highlight the need for equitable treatment approaches. The discussion of measurable residual disease (MRD) assessment for prognostication and treatment planning is also highlighted. This review highlights the need for continued research and integration of novel therapies to optimize patient outcomes in chronic lymphocytic leukemia.

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慢性淋巴细胞白血病的诊断和治疗：巴西血液学和血液治疗协会（ABHH）慢性淋巴细胞白血病巴西小组的2025条建议

慢性淋巴细胞白血病是最常见的成人白血病，其特征是单克隆B淋巴细胞的积累。这种疾病主要影响老年人，在诊断时无症状的比例很大。这份手稿提供了一个全面的审查慢性淋巴细胞白血病，包括其流行病学，临床表现，诊断标准和治疗策略。预后因素，特别是IGHV突变状态和染色体异常，作为疾病行为和治疗反应的关键决定因素进行了讨论。靶向治疗的最新进展，如布鲁顿酪氨酸激酶抑制剂（BTKi）和b细胞淋巴瘤2抑制剂（BCL-2i），通过显示优于化学免疫治疗的疗效，改变了治疗前景。然而，特别是在巴西等低收入和中等收入国家，获得医疗服务方面的差距突出了采取公平治疗方法的必要性。讨论可测量的残余病（MRD）评估的预后和治疗计划也被强调。这篇综述强调了继续研究和整合新疗法以优化慢性淋巴细胞白血病患者预后的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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