Nasnas Patrice, Cerchione Claudio, Musuraca Gerardo, Martinelli Giovanni, Ferrajoli Alessandra
Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Hematol Rep. 2023 Aug 1;15(3):454-464. doi: 10.3390/hematolrep15030047.
Chronic lymphocytic leukemia (CLL), is a hematologic malignancy characterized by the uncontrolled proliferation of mature B lymphocytes. CLL is the most prevalent leukemia in Western countries. Its presentation can range from asymptomatic with the incidental finding of absolute lymphocytosis on a routine blood test, to symptomatic disease requiring immediate intervention. Prognosis of the disease is defined by the presence or absence of specific mutations such as TP53, chromosomal abnormalities such as del(17p), a type of IGHV mutational status, and elevation of B2M and LDH. Treatment of CLL in the United States and Europe has evolved over the recent years thanks to the development of targeted therapies. The standard of care has shifted from traditional chemoimmunotherapy approaches to targeted therapies including Bruton tyrosine kinase inhibitors (BTKis) and BCL2 inhibitors, administered either as monotherapy or in combination with CD20 monoclonal antibodies. Several clinical trials have also recently evaluated combinations of BTKi and venetoclax and showed the combination to be well tolerated and able to induce deep remissions. Targeted therapies have a good safety profile overall; however, they also have unique toxicities that are important to recognize. Diarrhea, fatigue, arthralgia, infections, cytopenias, bleeding, and cardiovascular toxicities (including atrial fibrillation, ventricular arrhythmias, and hypertension) are the adverse events (AEs) commonly associated with BTKis. Initiation of therapy with venetoclax requires close monitoring because of the risk for tumor lysis syndrome associated with this agent, particularly in patients with a high disease burden. Development of newer target therapies is ongoing and the therapeutic landscape in CLL is expanding rapidly.
慢性淋巴细胞白血病(CLL)是一种血液系统恶性肿瘤,其特征为成熟B淋巴细胞的不受控制的增殖。CLL是西方国家最常见的白血病。其表现范围从常规血液检查时偶然发现绝对淋巴细胞增多的无症状状态,到需要立即干预的有症状疾病。该疾病的预后由特定突变(如TP53)的存在与否、染色体异常(如del(17p))、一种IGHV突变状态以及B2M和LDH的升高来定义。近年来,由于靶向治疗的发展,美国和欧洲对CLL的治疗有了进展。治疗标准已从传统的化学免疫疗法转向靶向治疗,包括布鲁顿酪氨酸激酶抑制剂(BTKis)和BCL2抑制剂,可作为单一疗法或与CD20单克隆抗体联合使用。最近的几项临床试验也评估了BTKi与维奈托克的联合使用情况,结果显示该联合用药耐受性良好且能够诱导深度缓解。总体而言,靶向治疗具有良好的安全性;然而,它们也有一些需要认识到的独特毒性。腹泻、疲劳、关节痛、感染、血细胞减少、出血和心血管毒性(包括心房颤动、室性心律失常和高血压)是与BTKis通常相关的不良事件(AE)。由于与该药物相关的肿瘤溶解综合征风险,尤其是在疾病负担高的患者中,使用维奈托克开始治疗需要密切监测。更新的靶向治疗正在研发中,CLL的治疗前景正在迅速扩展。
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