Signaling the end of chronic lymphocytic leukemia: new frontline treatment strategies
Cet article passe en revue les travaux récents sur le diagnostic et les traitements de la leucémie lymphocytaire chronique
The management of chronic lymphocytic leukemia (CLL) is undergoing profound changes. Several new drugs have been approved for CLL treatment (fludarabine, bendamustine and the monoclonal antibodies, alemtuzumab, rituximab, and ofatumumab) and many more drugs are in advanced clinical development to be approved for the treatment of CLL. In addition, the extreme heterogeneity of the clinical course as well as our improved ability for foreseeing the prognosis of this leukemia by the use of clinical, biological and genetic parameters now allow us to characterize patients with a very mild onset and course, an intermediate prognosis and a very aggressive course with high risk leukemia. On this background it becomes increasingly challenging to select the right treatment strategy for each condition. This paper summarizes the currently available diagnostic and therapeutic tools and gives an integrated recommendation of how to manage CLL in 2013. Moreover, it tries to give a perspective how we might integrate the novel agents for CLL therapy into sequential treatment approaches in the near future.