Standard of care and novel treatments for chronic lymphocytic leukemia.
OBJECTIVE
The standard of care and novel treatments for chronic lymphocytic leukemia (CLL) are reviewed.


CONCLUSIONS
Recent advances in the treatment of CLL have dramatically changed the therapeutic landscape for both patients and health care professionals. The majority of conventional first-line therapies are noncurative and are only used to treat disease that is symptomatic or progressive and include chlorambucil, monotherapy with purine analogues, and combination chemotherapy. Immunotherapeutic agents such as rituximab and alemtuzumab may be indicated in select patient populations. However, because clinical trials have found that overall survival does not depend on the initial therapy, selection of first-line therapy should be based on patient-specific factors and the patient's goals for therapy with respect to response, survival, and symptom palliation. Progression-free survival time and time to treatment are critical endpoints for CLL treatment. An increasingly important endpoint is minimal residual disease (MRD), as it is considered to be the major cause of relapse in CLL. Finally, comparison of toxicities between different therapies is critical in CLL, as it is in other disease states. Several new agents are currently being evaluated for use in CLL, including alvocidib, oblimersen, and lumiliximab.


CONCLUSIONS
Chemotherapy remains the mainstay of treatment for the majority of patients with CLL. The introduction of rituximab, alemtuzumab, and bendamustine has improved the current outlook for patients with CLL. As overall survival does not appear to depend on the initial therapy, treatment should be selected based on patient-specific factors and goals. Challenges in CLL include determining when to initiate therapy, eradicating MRD, and managing therapeutic resistance.
Seung
Amy Hatfield
AH
Oncology Pharmacy Residency, Johns Hopkins Hospital, 600 North Wolfe Street/Carnegie 180, Baltimore, MD 21287, USA. ahatfie2@jhmi.edu
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D059039:Standard of Care
D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents