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西班牙慢性淋巴细胞白血病临床指南:慢性淋巴细胞白血病管理的更新

Update of the Grupo Español de Leucemia Linfocítica Crónica clinical guidelines of the management of chronic lymphocytic leukemia.

作者信息

García-Marco José A, Delgado Julio, Hernández-Rivas José A, Ramírez Payer Ángel, Loscertales Pueyo Javier, Jarque Isidro, Abrisqueta Pau, Giraldo Pilar, Martínez Rafael, Yáñez Lucrecia, Terol Mª José, González Marcos, Bosch Francesc

机构信息

Servicio de Hematología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España.

Servicio de Hematología, Hospital Clínic i Provincial, Barcelona, España.

出版信息

Med Clin (Barc). 2017 Apr 21;148(8):381.e1-381.e9. doi: 10.1016/j.medcli.2016.12.030. Epub 2017 Feb 22.

Abstract

BACKGROUND AND OBJECTIVE

The broad therapeutic arsenal and the biological heterogeneity of patients with chronic lymphocytic leukemia (CLL) makes it difficult to standardize treatment for CLL patients with specific clinical settings in routine clinical practice. These considerations prompted us to elaborate the present consensus document, which constitutes an update of the previous version published in 2013, mainly focusing on novel treatment strategies that have been developed over last 5 years, namely B-cell receptor inhibitors (ibrutinib and idelalisib), anti-CD20 monoclonal antibodies (ofatumumab and obinutuzumab), and Bcl-2 inhibitors (venetoclax).

MATERIAL AND METHODS

A group of experts from the Spanish Chronic Lymphocytic Leukemia Group reviewed all published literature from January 2010 to January 2016, in order to provide recommendations based on clinical evidence. For those areas without strong scientific evidence, the panel of experts established consensus criteria based on their clinical experience.

RESULTS

The project has resulted in several practical recommendations that will facilitate the diagnosis, treatment, and follow-up of patients with CLL.

CONCLUSIONS

There are many controversial issues in the management of CLL with no appropriate studies for making consensus recommendations.

摘要

背景与目的

慢性淋巴细胞白血病(CLL)患者的治疗手段广泛且生物学特性存在异质性,这使得在常规临床实践中针对特定临床情况的CLL患者进行标准化治疗变得困难。这些因素促使我们精心制定本共识文件,它是2013年发布的上一版的更新版本,主要聚焦过去5年中开发的新型治疗策略,即B细胞受体抑制剂(依鲁替尼和idelalisib)、抗CD20单克隆抗体(奥法木单抗和奥妥珠单抗)以及Bcl-2抑制剂(维奈克拉)。

材料与方法

西班牙慢性淋巴细胞白血病研究小组的一组专家回顾了2010年1月至2016年1月期间所有发表的文献,以便根据临床证据提供建议。对于那些缺乏有力科学证据的领域,专家小组根据他们的临床经验制定了共识标准。

结果

该项目产生了若干实用建议,将有助于CLL患者的诊断、治疗和随访。

结论

在CLL的管理中存在许多有争议的问题,尚无适当的研究来达成共识性建议。

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