Columbia University Medical Center, NY, USA.
Associate Attending, Leukemia Service, Director of the Chronic Lymphocytic Leukemia Program, Hematologic Malignancies Section, Herbert Irving Comprehensive Cancer Center, New York-Presbyterian/Columbia University Medical Center, NY, USA.
Curr Hematol Malig Rep. 2020 Apr;15(2):72-82. doi: 10.1007/s11899-020-00563-8.
The treatment landscape of chronic lymphocytic leukemia has been rapidly evolving over the past few years. The prior standard of care, chemoimmunotherapy, is being replaced by targeted agents, and the utility of chemotherapy has come under question. In this review, we examine recent data comparing chemoimmunotherapy to targeted agents, how these data impact clinical management, and whether there are potential future roles for cytotoxic chemotherapy.
Clinical trials have shown improved clinical outcomes with targeted agents compared to traditional chemoimmunotherapy. Based on these data, the current treatment paradigm primarily favors targeted agents over chemoimmunotherapy, with a few exceptions. However, targeted agents have notable limitations, and thus, there may be a future role of cytotoxic chemotherapy when administered in combination with targeted agents. Although targeted agents have nearly replaced chemoimmunotherapy in the treatment of chronic lymphocytic leukemia, novel combinations utilizing chemotherapy are being developed that may lead to better outcomes.
过去几年中，慢性淋巴细胞白血病的治疗领域发展迅速。此前的标准治疗方案（化疗免疫疗法）正逐渐被靶向药物所取代，化疗的应用也受到了质疑。在这篇综述中，我们研究了最近比较化疗免疫疗法与靶向药物的数据，这些数据如何影响临床管理，以及细胞毒性化疗是否有潜在的未来作用。
临床试验表明，与传统化疗免疫疗法相比，靶向药物可改善临床结局。基于这些数据，目前的治疗模式主要倾向于靶向药物而非化疗免疫疗法，但也有一些例外。然而，靶向药物存在明显的局限性，因此，在与靶向药物联合应用时，细胞毒性化疗可能仍有其未来作用。虽然靶向药物在慢性淋巴细胞白血病的治疗中几乎已取代化疗免疫疗法，但正在开发新的联合化疗方案，可能会带来更好的疗效。
