Vol 1, No 4 (2010)
Review paper
Published online: 2010-11-24

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Individual therapeutic approaches in chronic lymphocytic leukemia

Krzysztof Warzocha
Hematologia 2010;1(4):306-319.

Abstract

Chronic lymphocytic leukemia (CLL) has the highest prevalence of any adult leukemia. In the majority of patients, therapy should be aimed to obtain complete remission (CR) and to prolong its duration (PFS) and overall survival (OS). The best results are presently reported with combined immunochemotherapy, based on fludarabine, cyclophosphamide and rituximab (FCR). Although CR, eradication of minimal residual disease (MRD) or molecular remission (MR) could be obtained in some patients treated with FCR, available data indicate that its use, even with the support of intensive chemotherapy and autologous hematopoietic stem cell transpotentially curative therapy for CLL, however, the major transplant-related mortality (TRM) have restricted the use of myeloablative strategy in this setting. New management options, such as reduced conditioning allogeneic transplants (RIC) have emerged, which will hopefully improve transplant tolerability as well as its applicability to a wider population of patients. However, it should be highlighted that in patients with limited disease no cytoreductive therapy is indicated until progression, and on the other hand, it should be avoided or reduced in older population of patients with advanced disease, poor performance status and comorbidities.
Hematologia 2010; 1, 4: 306-319

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