Owen Carolyn, Assouline Sarit, Kuruvilla John, Uchida Cassandra, Bellingham Catherine, Sehn Laurie
Division of Hematology and Hematological Malignancies, Foothills Medical Centre, Calgary, Alberta, Canada.
Division of Hematology, McGill University, Jewish General Hospital, Montreal, Quebec, Canada.
Clin Lymphoma Myeloma Leuk. 2015 Nov;15(11):627-634.e5. doi: 10.1016/j.clml.2015.07.649. Epub 2015 Aug 5.
Chronic lymphocytic leukemia (CLL) is the most common adult lymphoproliferative disorder in Western countries. The current standard of care for CLL is chemoimmunotherapy, typically with fludarabine, cyclophosphamide, and rituximab (FCR). However, most patients with CLL are elderly with comorbidities and are unable to tolerate FCR. In order to choose the best treatment for each individual patient, physicians must balance efficacy with toxicity. In addition, most currently available treatments are ineffective in CLL patients with loss of TP53. Two groups of novel therapeutic agents-anti-CD20 monoclonal antibodies and small molecule inhibitors-are attempting to address these issues, and 5 of these agents have progressed to phase 3 trials: obinutuzumab, idelalisib, ibrutinib, venetoclax (ABT-199), and duvelisib (IPI-145). We present the current evidence for these novel agents in the treatment of CLL, along with the perspectives of 4 Canadian oncology experts.
慢性淋巴细胞白血病（CLL）是西方国家最常见的成人淋巴细胞增殖性疾病。目前CLL的标准治疗方法是化学免疫疗法，通常使用氟达拉滨、环磷酰胺和利妥昔单抗（FCR）。然而，大多数CLL患者是患有合并症的老年人，无法耐受FCR。为了为每位患者选择最佳治疗方案，医生必须在疗效和毒性之间取得平衡。此外，目前大多数可用治疗方法对TP53缺失的CLL患者无效。两类新型治疗药物——抗CD20单克隆抗体和小分子抑制剂——正试图解决这些问题，其中5种药物已进入3期试验：奥滨尤妥珠单抗、idelalisib、伊布替尼、维奈克拉（ABT - 199）和度维利塞（IPI - 145）。我们展示了这些新型药物治疗CLL的当前证据，以及4位加拿大肿瘤学专家的观点。
