University of California Irvine, 200 S. Manchester Avenue, Suite 400, Room 428, ZOT 4061, Orange, Irvine, CA, 92868, USA.
Curr Hematol Malig Rep. 2024 Apr;19(2):65-74. doi: 10.1007/s11899-024-00726-x. Epub 2024 Feb 10.
The therapeutic landscape for chronic lymphocytic leukemia (CLL) has undergone a complete makeover following the introduction of highly effective targeted therapies, beginning with ibrutinib which first attained regulatory approval for CLL in 2014.
In recent years, we have seen further refinement of therapeutic options with the development of newer-generation Bruton's tyrosine kinase inhibitors (BTKi) including acalabrutinib and zanubrutinib that improve upon the safety of ibrutinib. Additionally, venetoclax-based approaches, combined with anti-CD20 antibodies, have allowed for time-limited targeted therapeutic strategies which are particularly attractive for certain subsets of patients though have demonstrated efficacy across all subgroups. Lastly, there is an ongoing movement toward the development of time-limited strategies inclusive of both a BTKi and venetoclax that may further widen potential options. CLL patients requiring frontline therapy have a unique burden of choice between highly effective therapies that differ substantially with respect to side effect profiles and schedules. This review will focus on the frontline management of CLL in the setting of these rapidly changing options.
慢性淋巴细胞白血病（CLL）的治疗领域在引入高效靶向治疗后发生了彻底改变，首个获批用于 CLL 的药物伊布替尼于 2014 年问世。
近年来，随着新一代布鲁顿酪氨酸激酶抑制剂（BTKi）的发展，我们看到了治疗选择的进一步细化，包括阿卡替尼和泽布替尼，它们改善了伊布替尼的安全性。此外，基于 venetoclax 的方法与抗 CD20 抗体联合使用，使限时靶向治疗策略得以实现，该策略对某些特定亚组患者具有吸引力，但已在所有亚组中显示出疗效。最后，目前正在开发包括 BTKi 和 venetoclax 的限时治疗策略，这可能会进一步扩大潜在的选择。需要一线治疗的 CLL 患者在具有显著不同副作用谱和治疗方案的高效治疗方法之间面临独特的选择负担。本综述将重点讨论在这些快速变化的选择下 CLL 的一线管理。
