City of Hope Medical Center, 1500 E Duarte Rd., Duarte, CA, 91010, USA.
Cancer Treat Res. 2021;181:133-149. doi: 10.1007/978-3-030-78311-2_8.
Chronic lymphocytic leukemia (CLL), the most common leukemia in the western world, is characterized by the accumulation of monoclonal B-lymphocytes in the bone marrow and lymphoid organs. Signaling via the B-cell receptor and Bruton tyrosine kinase (BTK) as well as resistance to apoptosis mediated by Bcl-2 are hallmarks of CLL biology and have been exploited in recent years to revolutionize management. As a result of the development of novel therapies, most CLL patients now can be spared conventional chemotherapy and can be treated using highly effective regimens consisting of BTK inhibitors, the Bcl-2 inhibitor venetoclax, and anti -CD20 monoclonal antibodies. The impact of novel therapies is particularly pronounced for high-risk cases including those with TP53 deletions/mutations who previously had a dismal outcome with conventional chemoimmunotherapy. Allogeneic HCT is a potentially curative option for selected younger patients with multiply relapsed high-risk disease.
慢性淋巴细胞白血病（CLL）是西方世界最常见的白血病，其特征是骨髓和淋巴器官中单克隆 B 淋巴细胞的积累。B 细胞受体和布鲁顿酪氨酸激酶（BTK）的信号传导以及 Bcl-2 介导的抗细胞凋亡是 CLL 生物学的标志，近年来已被用于彻底改变治疗方法。由于新型疗法的发展，现在大多数 CLL 患者可以避免使用传统化疗，而可以使用由 BTK 抑制剂、Bcl-2 抑制剂 venetoclax 和抗 CD20 单克隆抗体组成的高效方案进行治疗。新型疗法的影响对于高危病例尤其明显，包括那些具有 TP53 缺失/突变的病例，这些病例以前在接受传统化疗免疫治疗后预后不良。对于某些多次复发的高危疾病的年轻患者，同种异体 HCT 是一种潜在的治愈选择。
