Treatment of relapsed chronic lymphocytic leukemia

Abstract

Chronic lymphocytic leukemia (CLL) is common lymphoid malignancy characterized by a heterogeneous clinical course. Only patients with active disease require antileukemic therapy both in first-line and relapsed settings. With the introduction of novel targeted agents, treatment of CLL is currently undergoing a profound change. Frontline treatment may be repeated if the relapse occurs at least 24-36 months after chemoimmunotherapy and if TP53 abberation was excluded. If relapse occurs earlier, therapy should be changed using new compounds like ibrutinib, idelalisib or venetoclax. The two kinase inhibitors ibrutinib and idelalisib inhibit B-cell receptor (BCR) signaling and venetoclax is a selective Bcl-2 inhibitor. All these agents have demonstrated remarkable activity in patients with relapsed CLL, including patients with high-risk deletion of the 17p chromosome and/or TP53 mutation. This article reviews the potential therapeutic options for patients with relapsed CLL.