title: Update on therapy of chronic lymphocytic leukemia.
abstract: There have been tremendous advances in the treatment of chronic lymphocytic leukemia (CLL) over the past decade, with the goal of therapy no longer being just to palliate symptoms but now to achieve complete remission, eradicate minimal residual disease, and improve survival. During this period, there have also been major advances in identification of molecular factors associated with increased risk of progression. The clinical utility of these factors is being explored to determine whether we can identify groups of patients who should be treated earlier in their disease course and whether we can tailor therapy for groups of patients with specific molecular markers of disease. First-line chemoimmunotherapy approaches now offer prolonged survival, and there is a need to identify patients who are suitable candidates for allogeneic stem-cell transplantation that uses reduced-intensity conditioning regimens. The vast majority of CLL patients are either too old or do not have sufficiently high-risk disease to warrant these approaches, and effective therapies that can be tolerated by the more frail elderly patients with this disease are urgently needed. Numerous novel agents are being developed, and their role in the first-line treatment of frail patients or those who relapse after previous treatment is being explored in clinical trials.
authors.affiliation: Barts Cancer Institute, Barts and London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom. j.gribben@qmul.ac.uk
authors.forename: John G
authors.initials: JG
authors.lastname: Gribben
authors.forename: Susan
authors.initials: S
authors.lastname: O'Brien
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000188:drug therapy; D002869:Chromosome Aberrations; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D007135:Immunoglobulin Variable Region / Q000235:genetics; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000235:genetics / Q000401:mortality / Q000628:therapy*; D009154:Mutation; D011379:Prognosis; D027041:Somatic Hypermutation, Immunoglobulin
chemical_list: D007143:Immunoglobulin Heavy Chains; D007135:Immunoglobulin Variable Region