Department I of Internal Medicine, Center for Integrated Oncology Köln Bonn, Center of Excellence on "Cellular Stress Responses in Aging-Associated Diseases," University of Cologne, Cologne, Germany.
Blood. 2013 Nov 28;122(23):3723-34. doi: 10.1182/blood-2013-05-498287. Epub 2013 Sep 24.
The management of chronic lymphocytic leukemia (CLL) is undergoing profound changes. Several new drugs have been approved for CLL treatment (fludarabine, bendamustine, and the monoclonal antibodies alemtuzumab, rituximab, and ofatumumab) and many more drugs are in advanced clinical development to be approved for this disease. In addition, the extreme heterogeneity of the clinical course and our improved ability to foresee the prognosis of this leukemia by the use of clinical, biological, and genetic parameters now allow us to characterize patients with a very mild onset and course, an intermediate prognosis, or a very aggressive course with high-risk leukemia. Therefore, it becomes increasingly challenging to select the right treatment strategy for each condition. This article summarizes the currently available diagnostic and therapeutic tools and gives an integrated recommendation of how to manage CLL in 2013. Moreover, I propose a strategy how we might integrate the novel agents for CLL therapy into sequential treatment approaches in the near future.
慢性淋巴细胞白血病（CLL）的治疗正在发生深刻的变化。已有数种新药获批用于 CLL 治疗（氟达拉滨、苯达莫司汀以及单克隆抗体阿仑单抗、利妥昔单抗和奥法妥木单抗），还有更多的药物正在进行临床试验，准备用于 CLL 的治疗。此外，这种白血病的临床过程存在极端的异质性，而且我们通过临床、生物学和遗传学参数来预测疾病预后的能力也得到了提高，现在我们能够对起病和病程非常轻微、预后中等或起病和病程非常侵袭性、具有高风险的白血病患者进行特征描述。因此，为每个患者选择合适的治疗策略变得越来越具有挑战性。本文总结了目前可用的诊断和治疗手段，并对 2013 年 CLL 的治疗提出了综合建议。此外，我还提出了一种策略，即在不久的将来如何将新型 CLL 治疗药物整合到序贯治疗方法中。
