open access

Vol 47, No 3 (2016)
Prace poglądowe / Reviews
Published online: 2016-07-01
Submitted: 2016-06-30
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Diagnostic and therapeutic recommendations of the Polish Society of Hematology and Transfusion Medicine and Polish Adult Leukemia Group-CLL for chronic lymphocytic leukemia in 2016

Tadeusz Robak1, Iwona Hus2, Krzysztof Giannopoulos34, Jerzy Błoński1, Krzysztof Jamroziak5, Jacek Roliński6, Piotr Smolewski7, Dariusz Wołowiec8
DOI: 10.1016/j.achaem.2016.08.003
·
Acta Haematol Pol 2016;47(3):169-183.
Affiliations
  1. Klinika Hematologii, Uniwersytet Medyczny w Łodzi, Wojewódzki Szpital Specjalistyczny im. M. Kopernika w Łodzi, Kierownik: prof. dr hab. med. Tadeusz Robak, Łódź, Polska
  2. Samodzielna Pracownia Transplantologii Klinicznej, Uniwersytet Medyczny w Lublinie, Kierownik: prof. dr hab. med. Iwona Hus, Lublin, Polska
  3. Zakład Hematoonkologii Doświadczalnej, Uniwersytet Medyczny w Lublinie, Kierownik: prof. dr hab. med. Krzysztof Giannopoulos, Lublin, Polska
  4. Oddział Hematologiczny, Centrum Onkologii Ziemi Lubelskiej im. św. Jana z Dukli w Lublinie, Kierownik: prof. dr hab. med. Krzysztof Giannopoulos, Lublin, Polska
  5. Instytut Hematologii i Transfuzjologii, Warszawa. Dyrektor: prof. dr hab. n. med. Krzysztof Warzocha, Warszawa, Polska
  6. Zakład Immunologii Klinicznej, Uniwersytet Medyczny w Lublinie: Kierownik: prof. dr hab. Jacek Roliński, Lublin, Polska
  7. Zakład Hematologii Doświadczalnej, Uniwersytet Medyczny w Łodzi, Kierownik: prof. dr hab. med. Piotr Smolewski, Łódź, Polska
  8. Katedra i Klinika Hematologii, Nowotworów Krwi i Transplantacji Szpiku Akademii Medycznej we Wrocławiu, Kierownik: prof. dr hab. Kazimierz Kuliczkowski, Wrocław, Polska

open access

Vol 47, No 3 (2016)
Prace poglądowe / Reviews
Published online: 2016-07-01
Submitted: 2016-06-30

Abstract

The management of patients with chronic lymphocytic leukaemia (CLL) is currently undergoing improvements, particularly because of novel therapies. Purine analogs based immuno-chemotherapy, especially fludarabine combined with cyclophosphamide and rituximab (FCR), is still the current standard of care for first line therapy in younger, fit patients. However, its use in older, co-morbid patients is limited, particularly due to high toxicity. In fit patients older than 65 years or/and with previous infections bendamustine and rituximab (BR) should be considered instead of FCR. Recently, in patients with relevant comorbidities chlorambucil and anti CD20 monoclonal antibodies (rituximab, obinutuzumab or ofatumumab) are recommended as the first-line treatment. In addition, in 2014, two novel agents targeting the B cell receptor (BCR) signaling pathway, ibrutinib and idelalisib, were approved for patients with 17p deletion and/or p53 mutations and in the relapsed situation because of high efficacy and a favorable toxicity. Subsequently, ibrutinib has been approved to treat CLL patients regardless of their treatment history. Thus far it is recommended to treat patients with these agents until progression or unacceptable toxicity. The BCL-2 antagonist venetoclax is another oral drug with very promising preliminary data in patients refractory to immunochemotherapy as well as patients harboring del 17p. In 2014, the PTHiT and PALG-CLL group defined guidelines for the diagnosis, prognosis and treatment of CLL. In this article, we present updated recommendations for therapy of CLL.

Abstract

The management of patients with chronic lymphocytic leukaemia (CLL) is currently undergoing improvements, particularly because of novel therapies. Purine analogs based immuno-chemotherapy, especially fludarabine combined with cyclophosphamide and rituximab (FCR), is still the current standard of care for first line therapy in younger, fit patients. However, its use in older, co-morbid patients is limited, particularly due to high toxicity. In fit patients older than 65 years or/and with previous infections bendamustine and rituximab (BR) should be considered instead of FCR. Recently, in patients with relevant comorbidities chlorambucil and anti CD20 monoclonal antibodies (rituximab, obinutuzumab or ofatumumab) are recommended as the first-line treatment. In addition, in 2014, two novel agents targeting the B cell receptor (BCR) signaling pathway, ibrutinib and idelalisib, were approved for patients with 17p deletion and/or p53 mutations and in the relapsed situation because of high efficacy and a favorable toxicity. Subsequently, ibrutinib has been approved to treat CLL patients regardless of their treatment history. Thus far it is recommended to treat patients with these agents until progression or unacceptable toxicity. The BCL-2 antagonist venetoclax is another oral drug with very promising preliminary data in patients refractory to immunochemotherapy as well as patients harboring del 17p. In 2014, the PTHiT and PALG-CLL group defined guidelines for the diagnosis, prognosis and treatment of CLL. In this article, we present updated recommendations for therapy of CLL.

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Keywords

Chronic lymphocytic leukemia; Purine nucleoside analogs; Chlorambucil; Monoclonal antibodies; Idelalisib; Ibrutinib; Venetoclax

About this article
Title

Diagnostic and therapeutic recommendations of the Polish Society of Hematology and Transfusion Medicine and Polish Adult Leukemia Group-CLL for chronic lymphocytic leukemia in 2016

Journal

Acta Haematologica Polonica

Issue

Vol 47, No 3 (2016)

Pages

169-183

Published online

2016-07-01

DOI

10.1016/j.achaem.2016.08.003

Bibliographic record

Acta Haematol Pol 2016;47(3):169-183.

Keywords

Chronic lymphocytic leukemia
Purine nucleoside analogs
Chlorambucil
Monoclonal antibodies
Idelalisib
Ibrutinib
Venetoclax

Authors

Tadeusz Robak
Iwona Hus
Krzysztof Giannopoulos
Jerzy Błoński
Krzysztof Jamroziak
Jacek Roliński
Piotr Smolewski
Dariusz Wołowiec

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