Changing paradigms in the treatment of chronic lymphocytic leukemia.
Progress in our understanding of chronic lymphocytic leukemia and its treatment has resulted in a more tailored approach to patient management, with different therapeutic regimens for different patient populations. The current standard of care has evolved from single-agent therapy with chlorambucil or cyclophosphamide, through the introduction of purine analogs to the more recent introduction of chemoimmunotherapy. Selection of appropriate initial therapy should be based primarily on patient characteristics such as age, performance status and the expected clinical course of the leukemia based on established risk factors. Achieving a complete and durable response is the major goal for fit patients; chemoimmunotherapy with fludarabine, cyclophosphamide and rituximab would be advantageous. Alternatively, in unfit patients, controlling symptoms is the essential treatment goal and a regimen with a more favorable toxicity profile should be applied. This manuscript reviews the data that has lead to current treatment choices, advises on tailored therapies and discusses emerging trends. Data for this review was identified by a search of electronic information including Medline and PubMed databases, conference proceedings and trial registers. Critical analysis of extracted data was undertaken with attention to trial phase, treatment schedules and end points, including response rates, follow-up times, progression-free survival and overall survival.
Foon
K A
KA
Department of Hematological Malignancies, Nevada Cancer Institute, Las Vegas, NV 89135, USA. kfoon@nvcancer.org
Hallek
M J
MJ
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D000069461:Bendamustine Hydrochloride; D003520:Cyclophosphamide / Q000627:therapeutic use; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics / Q000401:mortality; D009588:Nitrogen Mustard Compounds / Q000627:therapeutic use; D011379:Prognosis; D011687:Purines / Q000008:administration & dosage
D000911:Antibodies, Monoclonal; D018906:Antineoplastic Agents, Alkylating; D009588:Nitrogen Mustard Compounds; D011687:Purines; D003520:Cyclophosphamide; D000069461:Bendamustine Hydrochloride