Cheson B D
Medicine Section, National Cancer Institute, Bethesda, MD 20892.
Crit Rev Oncol Hematol. 1991 Sep;11(3):167-77. doi: 10.1016/1040-8428(91)90019-9.
Chronic lymphocytic leukemia (CLL) is the most cormmon form of leukemia in adults in Western countries. After several decades of relative inactivity, important progress has been made in our understanding of the biology and immunology of this disorder. In addition, exciting therapeutic results have been achieved with several new, unique, and effective therapies. The most interesting chemotherapeutic agent is fludarabine, a purine analogue which achieves complete remission in 13% of relapsed or refractory patients and in greater than 30% of previously untreated patients; the overall response rates of 60% and 75%, respectively, are superior to reports with other single agents or combination regimens. Related drugs with promising activity are 2'-deoxycoformycin, and 2-chlorodeoxyadenosine. Preliminary studies are evaluating allogeneic and autologous bone marrow transplantation as potentially curative therapy. Biological approaches exploiting new insights into the immunology of CLL include the use of lymphoid growth factors. Interpretation of results of CLL studies has suffered from variability in eligibility and response criteria, especially definitions of complete remission. Recently published standardized guidelines for CLL clinical trials will facilitate comparisons among therapies and help identify those which are most promising. Continued progress will require integration of laboratory science and clinical investigation.
慢性淋巴细胞白血病（CLL）是西方国家成年人中最常见的白血病形式。在经历了几十年相对停滞不前的状态后，我们对这种疾病的生物学和免疫学的认识取得了重要进展。此外，几种新型、独特且有效的疗法也取得了令人振奋的治疗效果。最有趣的化疗药物是氟达拉滨，一种嘌呤类似物，在13%的复发或难治性患者以及超过30%的初治患者中可实现完全缓解；总体缓解率分别为60%和75%，优于其他单药或联合方案的报道。具有潜在活性的相关药物有2'-脱氧助间型霉素和2-氯脱氧腺苷。初步研究正在评估异基因和自体骨髓移植作为潜在的治愈性疗法。利用对CLL免疫学新认识的生物学方法包括使用淋巴生长因子。CLL研究结果的解读因入选标准和缓解标准的差异而受到影响，尤其是完全缓解的定义。最近发布的CLL临床试验标准化指南将有助于不同疗法之间的比较，并有助于确定最有前景的疗法。持续的进展将需要整合实验室科学和临床研究。
