Rekomendacje diagnostyczne i terapeutyczne dla przewlekłej białaczki limfocytowej w 2025 roku — Raport Grupy Roboczej PTHiT i PALG-CLL

Abstract

Chronic lymphocytic leukemia (CLL) is a disease of the elderly, with a median age at diagnosis of about 70 years. The natural course of the disease varies greatly, and patients with non-progressive and asymptomatic leukemia do not require therapy. However, treatment is indicated in advanced and/or progressive CLL. The results of CLL treatment have improved significantly in recent years, mainly due to the introduction of new and more effective drugs, including B-cell receptor (BCR) inhibitors and B-cell lymphoma 2 (BCL2) inhibitors. These new drugs are used continuously as monotherapy, or in combination regimens for specified periods. Venetoclax in combination with anti-CD20 antibodies is administered for 24 or 12 months (with rituximab and obinutuzumab, respectively), while the combination of venetoclax and ibrutinib is delivered in fifteen 28-day cycles. The choice of treatment protocol should largely depend on the assessment of 17p deletion/TP53 mutation and, in the first line of treatment, on the immunoglobulin variable heavy chain (IGVH) mutation status. In recent years, the role of immunochemotherapy in the treatment of CLL patients has become marginal. Patients presenting with indications for treatment should receive the novel targeted therapies, which are currently available in Poland under the National Health Fund’s drug program, in the first as well as in the subsequent treatment lines. This article provides an update on the standards of practice for diagnosis and therapy in 2025.