Department of Hematology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan.
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Clin Exp Hematop. 2020 Dec 15;60(4):130-137. doi: 10.3960/jslrt.20002. Epub 2020 May 13.
Treatment for patients with chronic lymphocytic leukemia (CLL) is becoming more individualized due to the recent introduction of novel molecularly targeted therapies into the therapeutic armamentarium. Genomic and molecular risk factors in CLL patients determine the individual risk for disease progression and response to therapy, and can impact survival. In this review article, we discuss current treatment strategies for CLL patients in Japan, where the novel targeted agents, the BTK inhibitor ibrutinib and BCL2 antagonist venetoclax, now are available and increasingly used in clinical practice. We also discuss the importance of CLL risk factors for making therapy decisions, focusing on immunoglobulin variable region heavy chain (IGHV) mutation status, 11q deletion, and 17p deletion. Treatment approaches for CLL have rapidly changed in the past few years because of these new targeted agents. They are highly effective, well tolerated, and have been demonstrated in a series of large randomized clinical trials to improve survival when compared with conventional chemotherapy-based treatment. Therefore, for most patients, especially high-risk CLL patients, BTK inhibitor and BCL2 antagonist therapies are preferred over chemo-immunotherapy. Currently ongoing studies seek to determine the best sequence for these new agents and whether a combination therapy approach is beneficial. With these developments, a new era of chemotherapy-free treatment for CLL patients is expected.
由于新型分子靶向治疗药物在治疗武器库中的引入，慢性淋巴细胞白血病（CLL）患者的治疗正变得越来越个体化。CLL 患者的基因组和分子危险因素决定了疾病进展和对治疗的反应的个体风险，并且可以影响生存。在这篇综述文章中，我们讨论了日本 CLL 患者的当前治疗策略，在日本，新型靶向药物 BTK 抑制剂伊布替尼和 BCL2 拮抗剂维奈托克现已上市，并在临床实践中越来越多地使用。我们还讨论了 CLL 危险因素在制定治疗决策中的重要性，重点讨论了免疫球蛋白可变区重链（IGHV）突变状态、11q 缺失和 17p 缺失。由于这些新的靶向药物，过去几年中 CLL 的治疗方法发生了迅速变化。它们非常有效，耐受性良好，并且在一系列大型随机临床试验中已被证明可改善生存，与基于常规化疗的治疗相比。因此，对于大多数患者，特别是高危 CLL 患者，BTK 抑制剂和 BCL2 拮抗剂治疗优于化疗免疫治疗。目前正在进行的研究旨在确定这些新药物的最佳顺序，以及联合治疗方法是否有益。随着这些进展，预计 CLL 患者将迎来无化疗治疗的新时代。
