Eichhorst Barbara, Cramer Paula, Hallek Michael
Department I for Internal Medicine and Center of Integrated Oncology, University of Cologne, Cologne, Germany.
CECAD-Cologne Cluster of Excellence in Cellular Stress Responses in Aging-associated Diseases.
Semin Oncol. 2016 Apr;43(2):241-50. doi: 10.1053/j.seminoncol.2016.02.005. Epub 2016 Feb 9.
Only chronic lymphocytic leukemia (CLL) patients with active or symptomatic disease or with advanced Binet or Rai stages require therapy. Prognostic risk factor profile and comorbidity burden are most relevant for the choice of treatment. For physically fit patients, chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab remains the current standard therapy. For unfit patients, treatment with an anti-CD20 antibody (obinutuzumab or rituximab or ofatumumab) plus milder chemotherapy (chlorambucil) may be applied. Patients with a del(17p) or TP53 mutation should be treated with the kinase inhibitors ibrutinib or a combination of idelalisib and rituximab. Clinical trials over the next several years will determine, whether kinase inhibitors, other small molecules, immunotherapeutics, or combinations thereof will further improve outcomes for patients with CLL.
仅患有活动性或症状性疾病、或处于Binet或Rai晚期的慢性淋巴细胞白血病（CLL）患者需要治疗。预后风险因素概况和合并症负担对于治疗选择最为相关。对于身体状况良好的患者，氟达拉滨、环磷酰胺和利妥昔单抗的化学免疫疗法仍然是当前的标准疗法。对于身体状况不佳的患者，可采用抗CD20抗体（奥滨尤妥珠单抗或利妥昔单抗或奥法木单抗）加较温和的化疗（苯丁酸氮芥）进行治疗。伴有del(17p)或TP53突变的患者应使用激酶抑制剂伊布替尼或idelalisib与利妥昔单抗的联合治疗。未来几年的临床试验将确定激酶抑制剂、其他小分子、免疫疗法或它们的组合是否会进一步改善CLL患者的预后。
