Treatment of chronic lymphocytic leukemia

Abstract

With the increasing options of treatment in chronic lymphocytic leukemia (CLL), choice of optimal therapy in frontline and relapse has become a more complex process. While early stage and asymptomatic CLL should still undergo watch and wait, patients with advanced stage disease are required to undergo genetic testing of CLL in order to enable optimal selection of treatment. Patients with favorable genetic profile still qualify for frontline therapy with chemoimmunotherapy. Novel targeted agents should be considered in patients with unmutated IGHV and particularly those with TP53 mutation or deletion. In relapsed CLL duration of remission to prior therapy as well as prior exposure to novel substances are leading the choice treatment. Btk inhibitors and the bcl2 inhibitor alone or in combination with rituximab can in this situation be considered as optimal therapy for the majority of patients.