Evolving strategies in primary therapy for chronic lymphocytic leukemia

Abstract

Chronic lymphocytic leukemia (CLL) has the highest prevalence of any adult leukemia. The last few years have defined some important prognostic factors, which should be taken into consideration upon treatment planning. 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 results with rituximab and/or alemtuzumab, as presented in the phase II studies and comparative analyses with historical patients treated with chemotherapy alone, warrants confirmation by prospective trials. 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. This article reviews the results of clinical trials, which have allowed defining new therapeutic strategies of CLL in recent years.