Haema 2013; 4(2):144-150
by Niki Stavroyianni
Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
Abstract
Chronic lymphocytic leukemia (CLL) is characterized by a highly variable clinical course. Among the biological features underlying this heterogeneity, genetic lesions and the mutational status of the immunoglobulin heavy chain variable genes (IGHV) are of importance. Therapeutic options in CLL have been considerably expanded during recent years. The combination of fludarabine, cyclophosphamide and rituximab (FCR) has become gold standard in the first-line treatment of physically fit patients. Bendamustine plus rituximab (BR) is currently being compared to FCR in studies and chlorambucil is still of relevance for elderly patients with comorbidities. Alemtuzumab is an alternative for high-risk patients (refractory CLL, 17p deletion, TP53 mutation). Allogeneic stem cell transplantation (allo-SCT) offers the only chance of cure but not without substantial mortality. Novel forms of reduced intensity conditioning have resulted in dramatic reduction of early morbidity and mortality of allogeneic stem cell transplantation (alloSCT), making this procedure now suitable for comorbid and elderly patients. This “new” alloSCT is working particularly well in CLL based on strong graft-versus-leukemia efficacy. New alloSCT is effective also in poor-risk CLL and can provide long-term disease-free survival. Innovative approaches focus on individualized, targeted therapies. A number of novel agents are in clinical trials and show marked efficacy combined with good tolerability.