Universität zu Köln

Eichhorst, B. and Hallek, M. (2015). Chronic lymphocytic leukemi. Treatment concepts in transition. Internist, 56 (4). S. 374 - 381. NEW YORK: SPRINGER. ISSN 1432-1289

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Abstract

Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western hemisphere and mainly affects elderly patients. No curative treatment is currently available for this disease. Advanced disease is treated according to the patients' fitness and comorbidity burden as well as according the presence of high risk genetic factors in CLL cells. The detection of del(17p) and/or TP53 gene mutations reflects a very unfavorable prognosis and refractoriness to chemotherapy (very high risk CLL). In physically fit patients without high comorbidity burden and without very high risk prognostic factors, chemoimmunotherapy containing fludarabine, cyclophosphamide, and the CD20 antibody rituximab (FCR) is standard therapy because this regimen has been shown to improve overall survival. In patients with significant comorbidity burden, a less intense chemoimmunotherapy regimen should be administered consisting of the alkylating agent chlorambucil plus CD20 antibody. In very high risk patients, kinase inhibitors blocking the signaling transduction pathway of the B cell receptor have been approved since 2014. The same substances are also approved in relapsed CLL. However, in relapsed CLL repetitive administration of chemoimmunotherapy is still an alternative treatment option, especially if the first remission was longer lasting (> 24 months). Allogeneic hematopoietic stem cell transplantation in very high risk CLL or early relapsed disease has become less important than in the past. In some patients considering the risk of the transplantation versus the risk of failing to respond to the new treatment option, this procedure might still be the treatment of choice in order to achieve long-lasting remissions. In the choice of treatment for patients with CLL, several factors must be considered. Because of the broad spectrum of treatment options, therapy within a clinical study is still the best treatment option.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Eichhorst, B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-408144
DOI:	10.1007/s00108-014-3593-8
Journal or Publication Title:	Internist
Volume:	56
Number:	4
Page Range:	S. 374 - 381
Date:	2015
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-1289
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PREVIOUSLY UNTREATED PATIENTS; STEM-CELL TRANSPLANTATION; PHASE-II TRIAL; PLUS CHLORAMBUCIL; OPEN-LABEL; RITUXIMAB; CLL; BENDAMUSTINE; MULTICENTER; IBRUTINIB Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/40814