Abbott Brian L
Department of Medicine, University of Missouri, Kansas City, MO, USA.
Clin Adv Hematol Oncol. 2004 Jul;2(7):448-54.
Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults, accounting for up to 25% of all newly diagnosed leukemia. Many cases of CLL have a non-aggressive course and often do not require treatment, while other cases exhibit rapid progression within several years. Recent advances in the diagnosis of CLL include the identification of several prognostic factors, such as ZAP70 expression and the absence of immunoglobulin gene rearrangements. These prognostic factors may identify subgroups of CLL patients who would benefit from earlier treatment rather than "watchful waiting." New combination treatment regimens that include nucleoside analogs (fludarabine, cladribine, and pentostatin) and monoclonal antibodies (rituximab and alemtuzumab) have resulted in improved rates of complete remissions in newly diagnosed and relapsed CLL patients; many of these are molecular complete remissions. The only known cure for CLL remains allogeneic hematopoietic cell transplantation. Newer conditioning strategies with lower, nonmyeloablative doses of chemotherapy and radiation therapy have made this option available to a broader group of patients, including older and sicker populations. These advances in prognostic factors, chemotherapy regimens, and allogeneic transplantation will likely enable increases in survival for CLL patients.
慢性淋巴细胞白血病（CLL）是成人中最常见的白血病类型，占所有新诊断白血病的25%。许多CLL病例病程进展缓慢，通常不需要治疗，而其他病例则在数年内迅速进展。CLL诊断方面的最新进展包括识别出几种预后因素，如ZAP70表达和免疫球蛋白基因重排的缺失。这些预后因素可能有助于识别CLL患者亚组，这些患者可能从早期治疗而非“观察等待”中获益。包括核苷类似物（氟达拉滨、克拉屈滨和喷司他丁）和单克隆抗体（利妥昔单抗和阿仑单抗）的新联合治疗方案，已使新诊断和复发的CLL患者完全缓解率得到提高；其中许多是分子学完全缓解。CLL唯一已知的治愈方法仍然是异基因造血细胞移植。采用更低、非清髓剂量化疗和放疗的新型预处理策略，已使包括老年和病情较重人群在内的更广泛患者群体能够选择这一治疗方案。这些在预后因素、化疗方案和异基因移植方面的进展，可能会提高CLL患者的生存率。
