title: Initial therapy of chronic lymphocytic leukemia.
abstract: Only chronic lymphocytic leukemia (CLL) patients with active or symptomatic disease or with advanced Binet or Rai stages require therapy. Prognostic risk factor profile and comorbidity burden are most relevant for the choice of treatment. For physically fit patients, chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab remains the current standard therapy. For unfit patients, treatment with an anti-CD20 antibody (obinutuzumab or rituximab or ofatumumab) plus milder chemotherapy (chlorambucil) may be applied. Patients with a del(17p) or TP53 mutation should be treated with the kinase inhibitors ibrutinib or a combination of idelalisib and rituximab. Clinical trials over the next several years will determine, whether kinase inhibitors, other small molecules, immunotherapeutics, or combinations thereof will further improve outcomes for patients with CLL.
authors.affiliation: Department I for Internal Medicine and Center of Integrated Oncology, University of Cologne, Cologne, Germany. Electronic address: barbara.eichhorst@uk-koeln.de.
authors.forename: Barbara
authors.initials: B
authors.lastname: Eichhorst
authors.affiliation: CECAD-Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases.
authors.forename: Paula
authors.initials: P
authors.lastname: Cramer
authors.affiliation: Department I for Internal Medicine and Center of Integrated Oncology, University of Cologne, Cologne, Germany; CECAD-Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases.
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000066491:Clinical Decision-Making; D006801:Humans; D007167:Immunotherapy; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000628:therapy*; D058990:Molecular Targeted Therapy; D018579:Patient Selection; D016896:Treatment Outcome
keywords: Chemoimmunotherapy; Choice of therapy; Chronic lymphocytic leukemia; Kinase inhibitors