title: Evolving Strategies for the Treatment of Chronic Lymphocytic Leukemia in the Upfront Setting.
abstract: Chronic lymphocytic leukemia (CLL) is a disease of marked clinical heterogeneity, and while some patients have a normal life expectancy, others develop rapidly progressive disease shortly after diagnosis. The current standard for upfront treatment of CLL is chemoimmunotherapy for younger fit patients, FCR (fludarabine, cyclophosphamide, and rituximab) being the prototype. For older patients, BR (bendamustine and rituximab) exhibits excellent activity with decreased toxicity. For the frailest patients, CD20 monoclonal antibodies with or without chlorambucil have proven to be efficacious. The novel oral kinase inhibitors ibrutinib and idelalisib are FDA-approved in the relapsed/refractory setting, and ibrutinib is approved upfront for those with del(17p). These drugs have produced long-term durable responses in the relapsed/refractory setting, and studies are underway using these as single agent upfront or in combination with both chemotherapy and monoclonal antibodies. Here, we review standard upfront therapies and new agents and combinations that are on the horizon for CLL.
authors.affiliation: Leukemia Service, Division of Hematology and Oncology, Department of Medicine, Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Spencer H
authors.initials: SH
authors.lastname: Bachow
authors.affiliation: Leukemia Service, Division of Hematology and Oncology, Department of Medicine, Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA. nl2129@cumc.columbia.edu.|College of Physicians and Surgeons, Columbia University Medical Center, 161 Fort Washington Avenue, 9th Floor, New York, NY, USA. nl2129@cumc.columbia.edu.
authors.forename: Nicole
authors.initials: N
authors.lastname: Lamanna
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D000069461:Bendamustine Hydrochloride / Q000008:administration & dosage; D006801:Humans; D007167:Immunotherapy; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage; D000069283:Rituximab / Q000008:administration & dosage
chemical_list: D047428:Protein Kinase Inhibitors; D000069283:Rituximab; D000069461:Bendamustine Hydrochloride
keywords: Chemoimmunotherapy; Chronic lymphocytic leukemia; De novo; Initial treatment; Small lymphocytic lymphoma; Treatment-naïve