Universität zu Köln

Cramer, Paula, Hallek, Michael and Eichhorst, Barbara (2016). State-of-the-Art Treatment and Novel Agents in Chronic Lymphocytic Leukemia. Oncol. Res. Treat., 39 (1-2). S. 25 - 32. BASEL: KARGER. ISSN 2296-5262

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Abstract

Chemoimmunotherapy is the established first-line treatment of patients with chronic lymphocytic leukemia (CLL) who do not display the high-risk genetic features del(17p) and/or TP53 mutation: Physically fit patients without or with only mild comorbidities should receive fludarabine, cyclophosphamide and rituximab, while bendamustine and rituximab can be considered in fit elderly patients of over 65 years and in patients with a higher risk of infections. Patients with relevant coexisting conditions should receive chlorambucil with a CD20 antibody, preferably obinutuzumab. Patients with a del(17p) and/or TP53 mutation respond poorly to conventional chemo(immuno) therapies. However, the recently approved BTK and PI3K inhibitors ibrutinib and idelalisib have the best efficacy ever documented in patients with these high-risk genomic alterations and/or refractory CLL. The choice between ibrutinib and idelalisib should be based on the patients' comorbidities and concomitant medications since both agents have a distinct toxicity profile, although they are generally well tolerated in the majority of patients. For treatment of patients with a late relapse, chemoimmunotherapy instead of kinase inhibitors is still a reasonable approach, but has to be determined for every patient individually. Further targeted drugs and their combinations are currently being evaluated in clinical trials and have the potential to eradicate all residual CLL cells and thus lead to a cure of CLL. (C) 2016 S. Karger GmbH, Freiburg

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Cramer, Paula UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Eichhorst, Barbara UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-293231
DOI:	10.1159/000443903
Journal or Publication Title:	Oncol. Res. Treat.
Volume:	39
Number:	1-2
Page Range:	S. 25 - 32
Date:	2016
Publisher:	KARGER
Place of Publication:	BASEL
ISSN:	2296-5262
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PREVIOUSLY UNTREATED PATIENTS; FLUDARABINE PLUS CYCLOPHOSPHAMIDE; STEM-CELL TRANSPLANTATION; PROGRESSION-FREE SURVIVAL; LOW-DOSE FLUDARABINE; PHASE-II TRIAL; GENOMIC ABERRATIONS; FRONTLINE TREATMENT; 1ST-LINE THERAPY; CLONAL EVOLUTION Multiple languages Oncology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/29323