An Overview About Management Of Chronic Lymphocytic Leukemia

Abstract

Background: Lymphoid neoplasms are broadly categorized into precursor lymphoid neoplasms and mature B-cell, T-cell, or natural killer (NK) cell neoplasms. Chronic lymphocytic leukaemia (CLL) is a malignancy of CD5+ B cells that is characterized by the accumulation of small, mature-appearing lymphocytes in the blood, marrow and lymphoisd tissues. Not all patients with CLL require treatment at the time of diagnosis, and most patients can undergo active surveillance for many years before treatment is needed. Indications for treatment are detailed in the 2008 iwCLL guidelines and are mainly based on 3 elements: symptoms, complete blood cell count, and physical examination findings. Response assessment is detailed in the iwCLL 2008 guidelines,22 although their timing and validity may be challenged by the advent of the new biological agents. Response should be assessed 2 to 3 months after the completion of therapy and should be based on complete blood cell count, physical examination findings, and bone marrow biopsy. Of interest, the clinical benefit of complete remission (CR) with incomplete bone marrow recovery seems to be comparable to that of CR. If criteria for CR are met but the bone marrow includes lymphocytic nodules, the recommended term is nodular partial remission, the prognosis of which is more similar to that of partial remission. Fit patients are good candidates for chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab. Patients who experience relapse from 24 to 36 months after frontline chemoimmunotherapy can be safely rechallenged with the same regimen, their median PFS after salvage therapy is only 21 months; even more disappointing outcomes are observed with the use of salvage FCR in high-risk patients. Treatments with antibodies such as rituximab and ofatumumab have been explored as consolidation strategies to prolong response duration, with moderate success.