Department of Hematology, University Hospital of Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Expert Rev Hematol. 2011 Feb;4(1):27-35. doi: 10.1586/ehm.10.84.
Over the past few years, more effective therapies have emerged in the treatment of chronic lymphocytic leukemia (CLL); these are mainly combinations of immunotherapy with fludarabine-based regimens. Despite the higher response rates obtained with these more intensive treatments, they may not always be applicable. Patients with several comorbidities have an increased toxicity with these newer therapies. Effective tools to distinguish between fit and nonfit patients and new therapeutic approaches suitable for fragile patients with CLL are therefore necessary. Moreover, there is still a subset of patients who are refractory to standard fludarabine-based treatments who continue to have very poor survival. Efforts to understand the mechanisms of resistance to treatment in order to develop new therapeutic agents for those patients are mandatory. Finally, advances in the knowledge of the pathogenesis of CLL are promoting the emergence of drugs directed to new biological targets of this disease. Consequently, trials exploring the toxicity profile and efficacy of these new therapeutic agents, alone or in combination with standard treatments, are warranted.
在过去的几年中，慢性淋巴细胞白血病（CLL）的治疗出现了更有效的疗法；这些主要是免疫疗法与氟达拉滨为基础的方案相结合。尽管这些更强化的治疗方法获得了更高的缓解率，但它们并非总是适用。患有多种合并症的患者使用这些新型疗法的毒性增加。因此，有必要开发有效的工具来区分适合和不适合的患者，并为脆弱的 CLL 患者提供合适的新治疗方法。此外，仍有一部分患者对标准的氟达拉滨为基础的治疗方案产生耐药性，其生存仍然非常差。为了开发针对这些患者的新治疗药物，有必要努力了解治疗耐药的机制。最后，对 CLL 发病机制的认识的进步正在推动针对该疾病新的生物靶点的药物的出现。因此，有必要探索这些新的治疗药物单独或与标准治疗联合使用的毒性特征和疗效的临床试验。
