Standards for the treatment of relapsed chronic lymphocytic leukemia: a case-based study

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BlankStandards for the treatment of relapsed chronic lymphocytic leukemia: a

case-based study.

AP Kater and SH Tonino

Clin Lymphoma Myeloma Leuk, June 1, 2010; 10 Suppl 1: S34-41.

Department of Hematology, Academic Medical Center, The Netherlands.

a.p.kater@...

In recent years, considerable advances have been made in first-line treatment

strategies for chronic lymphocytic leukemia (CLL). Combination of conventional

chemotherapy with immunotherapeutic agents is currently considered the most

active strategy, with improved progression-free survival and overall survival.

However, patients are not cured and invariably experience relapsing disease

requiring treatment. In contrast to the advances made in first-line treatment

strategies, much less progress has been made for patients with relapsed and

especially refractory CLL. The activity of most chemotherapeutic drugs used in

CLL rely on intact p53 function, and repeated cycles of therapy might eventually

result in drug resistance because of acquired cytogenetic alterations, mainly

affecting genes involved in the p53 response. As a consequence, most commonly

used treatment regimens are ineffective in patients with refractory disease. A

number of promising alternative treatment approaches are currently under

investigation. In this review, the approach to patients with relapsed and

refractory CLL and current promising experimental treatment options for these

distinct clinical patient categories are discussed.

PMID: 20529806