Abbott Brian L
University of Colorado Health Science Center, Aurora, Colorado, USA.
Cancer Invest. 2006 Apr-May;24(3):302-9. doi: 10.1080/07357900600620525.
Chronic lymphocytic leukemia is a low-grade B-lineage lymphoid malignancy. Based on recent findings, the disease appears to be more heterogeneous than previously thought. Many cases may require no treatment at all unless patients become symptomatic or develop signs of rapid progression. Even in this setting, treatment is noncurative and is directed at reducing the symptoms. Recently described molecular risk features may help delineate at initial diagnosis which patients will have a more aggressive course. Newer treatment regimens incorporating purine nucleoside analogs and monoclonal antibodies have increased the rate of molecular complete remissions, which may lead to increased survival. Reduced intensity conditioning regimens have made the potentially curative modality of allogeneic transplantation more widely available. All of these recent treatments have significant risks of infectious complications, which must be carefully weighed against the risks posed by the underlying disease, and many low-risk asymptomatic patients do not require any treatment. A proposed risk-based treatment algorithm will be discussed.
慢性淋巴细胞白血病是一种低度B淋巴细胞系恶性肿瘤。基于最近的研究发现，该疾病似乎比之前认为的更加异质性。许多病例可能根本无需治疗，除非患者出现症状或有快速进展的迹象。即便如此，治疗也无法治愈，而是旨在减轻症状。最近描述的分子风险特征可能有助于在初始诊断时确定哪些患者病程会更具侵袭性。包含嘌呤核苷类似物和单克隆抗体的新型治疗方案提高了分子完全缓解率，这可能会延长生存期。降低强度的预处理方案使异基因移植这种潜在的治愈性治疗方式更广泛可用。所有这些近期的治疗都有显著的感染并发症风险，必须仔细权衡其与基础疾病所带来风险的利弊，而且许多低风险无症状患者无需任何治疗。本文将讨论一种基于风险的拟议治疗算法。
