Yee Karen W L, O'Brien Susan M
Department of Leukemia, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Mayo Clin Proc. 2006 Aug;81(8):1105-29. doi: 10.4065/81.8.1105.
Traditionally, the goal of therapy in chronic lymphocytic leukemia (CLL) has been palliative, with first-line therapy using alkylating agents and/or involved field radiotherapy (depending on the stage of disease and sites of involvement) because of the older age of affected patients and the low rate of complete remissions (CRs) with no improvement in overall survival despite treatment. With increasing knowledge about the biology, molecular genetics, and prognostic factors of the disease, the philosophy of care for patients with CLL has evolved from palliation to aiming for a potential cure, especially in younger patients. Furthermore, multiple treatment options have emerged, including purine analogues, monoclonal antibodies, and potentially stem cell transplantation. These have been associated with higher frequencies of CRs and longer durations of responses compared to conventional chemotherapy. In addition, a subset of patients treated with chemoimmunotherapy can achieve durable CRs and molecular remissions. This may translate into improved disease-free survival and potentially a "cure." Because of the heterogeneous nature of CLL, new prognostic markers are currently being incorporated into clinical trials to determine their role in routine clinical practice. This review summarizes current therapeutic regimens that are being evaluated in patients with CLL and management of disease-related complications.
传统上，慢性淋巴细胞白血病（CLL）的治疗目标一直是姑息性的，一线治疗采用烷化剂和/或受累野放疗（取决于疾病分期和受累部位），这是因为患病患者年龄较大，且完全缓解（CR）率较低，尽管接受了治疗，但总生存期并未改善。随着对该疾病生物学、分子遗传学和预后因素的了解不断增加，CLL患者的治疗理念已从姑息治疗转变为追求潜在治愈，尤其是在年轻患者中。此外，出现了多种治疗选择，包括嘌呤类似物、单克隆抗体以及潜在的干细胞移植。与传统化疗相比，这些治疗方法与更高的CR频率和更长的缓解持续时间相关。此外，接受化学免疫疗法治疗的一部分患者可实现持久的CR和分子缓解。这可能转化为无病生存期的改善，并有可能实现“治愈”。由于CLL的异质性，目前新的预后标志物正被纳入临床试验，以确定它们在常规临床实践中的作用。本综述总结了目前正在CLL患者中评估的治疗方案以及疾病相关并发症的管理。
