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Review article
Published online: 2021-10-07
Submitted: 2021-10-07
Accepted: 2021-10-07
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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 2021

Iwona Hus12, Krzysztof Giannopoulos34, Krzysztof Jamroziak5, Jerzy Błoński6, Dariusz Wołowiec7, Jacek Roliński8, Piotr Smolewski9, Tadeusz Robak6
DOI: 10.5603/AHP.a2021.0087
Affiliations
  1. Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
  2. Department of Clinical Transplantology, Medical University of Lublin, Lublin, Poland
  3. Department of Experimental Hematooncology, Medical University of Lublin, Lublin, Poland
  4. Department of Hematology, St. John’s Cancer Center, Lublin, Poland
  5. Department of Hematology, Transplantology, and Internal Diseases, Central Clinical Hospital of UCK, Medical University of Warsaw, Warsaw, Poland
  6. Department of Hematology, Medical University of Lodz, Provincial Specialist Hospital M. Kopernika in Lodz, Lodz, Poland
  7. Department and Clinic of Hematology, Blood Cancer and Bone Marrow Transplantation, Medical University of Wroclaw, Wroclaw, Poland
  8. Department of Clinical Immunology, Medical University of Lublin, Lublin, Poland
  9. Department of Experimental Hematology, Medical University of Lodz, Lodz, Poland

open access

Ahead of print
REVIEW ARTICLE
Published online: 2021-10-07
Submitted: 2021-10-07
Accepted: 2021-10-07

Abstract

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, with a median age at diagnosis of approximately 70 years. The natural course of the disease varies greatly, and patients with non-progressive and asymptomatic leukemia do not require treatment. The results of CLL treatment have improved significantly in recent years, mainly due to the introduction of new, more effective drugs, including BCR inhibitors and BCL2 inhibitors. The new drugs are used continuously, while venetoclax in combination with anti-CD20 antibodies is used for 24 (rituximab) or 12 (obinutuzumab) months, depending on the type of antibody and line of therapy. The choice of treatment protocol should largely depend on the assessment of 17p deletion/TP53 mutation and immunoglobulin variable heavy chain (IGVH) mutation status, which correlate with a worse response to immunochemotherapy. The role of immunochemotherapy, which until recently was the mainstay of CLL treatment, has now significantly decreased. In the first-line, it is recommended only in patients without 17p deletion/TP53 mutation, with mutated IGVH. Other patients should receive novel targeted therapies. However, at the time of the preparation of these recommendations, these therapies are not available in the firs-line of treatment in Poland. Novel targeted therapies play a major role in the treatment of refractory/relapsed CLL, and immunochemotherapy is recommended primarily in patients with a long-term response to first-line therapy. In this article, we present an update of the guidelines for the diagnosis and treatment of CLL, including the treatment of autoimmune complications, as well as the prophylaxis and treatment of infections, developed by the Polish Society of Haematologists and Transfusiologists and PALG-CLL Working Group.

Abstract

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, with a median age at diagnosis of approximately 70 years. The natural course of the disease varies greatly, and patients with non-progressive and asymptomatic leukemia do not require treatment. The results of CLL treatment have improved significantly in recent years, mainly due to the introduction of new, more effective drugs, including BCR inhibitors and BCL2 inhibitors. The new drugs are used continuously, while venetoclax in combination with anti-CD20 antibodies is used for 24 (rituximab) or 12 (obinutuzumab) months, depending on the type of antibody and line of therapy. The choice of treatment protocol should largely depend on the assessment of 17p deletion/TP53 mutation and immunoglobulin variable heavy chain (IGVH) mutation status, which correlate with a worse response to immunochemotherapy. The role of immunochemotherapy, which until recently was the mainstay of CLL treatment, has now significantly decreased. In the first-line, it is recommended only in patients without 17p deletion/TP53 mutation, with mutated IGVH. Other patients should receive novel targeted therapies. However, at the time of the preparation of these recommendations, these therapies are not available in the firs-line of treatment in Poland. Novel targeted therapies play a major role in the treatment of refractory/relapsed CLL, and immunochemotherapy is recommended primarily in patients with a long-term response to first-line therapy. In this article, we present an update of the guidelines for the diagnosis and treatment of CLL, including the treatment of autoimmune complications, as well as the prophylaxis and treatment of infections, developed by the Polish Society of Haematologists and Transfusiologists and PALG-CLL Working Group.

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Keywords

chronic lymphocytic leukemia, fludarabine, cladribine, bendamustine, chlorambucil, rituximab, obinutuzumab, ibrutinib, venetoclax, acalabrutinib, idelalisib

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 2021

Journal

Acta Haematologica Polonica

Issue

Ahead of print

Article type

Review article

Published online

2021-10-07

DOI

10.5603/AHP.a2021.0087

Keywords

chronic lymphocytic leukemia
fludarabine
cladribine
bendamustine
chlorambucil
rituximab
obinutuzumab
ibrutinib
venetoclax
acalabrutinib
idelalisib

Authors

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

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