Chronic lymphocytic leukemia

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 and to prolong its duration and overall survival. The best results are presently reported with combined chemotherapy, based on purine analogs and cyclophosphamide. Further improvement of the therapy with the addition of rituximab, as presented in the phase II studies and comparative analyses with historical patients treated with chemotherapy alone, has been recently confirmed by a prospective trial. Although molecular remission has been reported in many patients treated with chemioimmunotherapy, available data indicate that its use, even with the support of autologous hematopoietic stem cell transplantation is not curative. Allogeneic transplantation is the only potentially curative therapy for CLL, however, the major treatment-related toxicity have restricted the use of myeloablative strategy in this setting. New management options such as non-myeloablative allogeneic transplants 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 some patients with limited disease no therapy is indicated untill progression, and on the other hand, the intensive chemotherapy should be avoided in older population of patients with advanced disease, poor performance status and comorbidities.