Current Treatment for Chronic Lymphocytic Leukemia

Valentin Goede, Michael Hallek
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引用次数: 1

Abstract

Within the past 15 years, the management of chronic lymphocytic leukemia (CLL) has shifted from palliative efforts to modern combination therapies that aim to induce durable remissions and prolong life. A widened spectrum of regimens and novel tools to predict response allows for the tailoring of first- and second-line treatment to a patient's individual risk, age, and medical fitness. Herein, we review current treatment indications and therapeutic options, followed by evidence-based recommendations for the choice of therapy in primary and relapsed CLL. Supported by phase III trial data, combined chemotherapy with fludarabine and cyclophosphamide is considered the standard first-line regimen. In all probability, however, chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab will become the standard therapy in the very near future. Patients at poor risk with genetic abnormalities, as well as elderly patients with medical impairments, require special attention because they often do not respond to these novel combination therapies. Salvage therapy (including hematopoietic stem cell transplantation) should be carried out in clinical trials whenever possible because no standard salvage regimen has been defined so far.

慢性淋巴细胞白血病的当前治疗
在过去的15年里,慢性淋巴细胞白血病(CLL)的治疗已经从姑息治疗转向了旨在诱导持久缓解和延长生命的现代联合治疗。更广泛的治疗方案和预测反应的新工具允许根据患者的个体风险、年龄和医疗健康状况定制一线和二线治疗。在此,我们回顾了目前的治疗适应症和治疗方案,其次是针对原发性和复发性CLL的治疗选择的循证建议。在III期试验数据的支持下,氟达拉滨和环磷酰胺联合化疗被认为是标准的一线方案。然而,在不久的将来,氟达拉滨、环磷酰胺和利妥昔单抗的化学免疫治疗很可能成为标准的治疗方法。有遗传异常的低风险患者以及有医学缺陷的老年患者需要特别注意,因为他们通常对这些新的联合疗法没有反应。抢救治疗(包括造血干细胞移植)应尽可能在临床试验中进行,因为到目前为止还没有确定标准的抢救方案。
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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