First-Line Treatment in Chronic Lymphocytic Leukemia: A Risk-Stratified Approach

Chronic lymphocytic leukemia (CLL) is the most common leukemia in Western countries, with recent evidence suggesting that the disease should be divided into high- and low-risk categories. First-line treatment strategies vary, but combination chemotherapy or chemoimmunotherapy has been an acceptable initial approach. It remains unclear whether patients at high risk should be treated similarly to patients at low risk, but clinical trials are attempting to resolve this issue. This review discusses the commonly used prognostic factors in CLL; reviews data on first-line therapy, with special focus on large prospective randomized studies; and provides insight as to how we might approach this disease using a risk-stratified approach.