Treatment of repeatedly relapsing chronic lymphocytic leukemia

Abstract

Chronic lymphocytic leukemia is one of the most common lymphoproliferative disorders in western population. Course and prognosis of the disease are very variable and they are influenced, among other factors, by typical cytogenetic changes and genetic mutations. Many patients never require treatment, whereas others die in spite of the treatment in short time from diagnosis. The treatment is based on classical chemotherapy, monoclonal antibodies and also targeted therapy, or possibly combination of these. Described case shows a significant part of current treatment approaches - chemoimmunotherapy with fludarabine, cyclophosphamide and rituximab in the 1. line of treatment, retreatment with the same combination in the situation of late relapse, treatment with idelalisib, high-dose corticosteroids and finally with venetoclax. We discuss different options, especially regarding modern targeted therapy, with emphasis on practical aspects as well as optimal sequencing of these options, including allogeneic hematopoietic stem cell transplantation.