RT Book, Section
A1 Jain, Nitin
A1 Thompson, Philip
A1 Bueso-Ramos, Carlos
A1 O'Brien, Susan M.
A1 Wierda, William G.
A2 Kantarjian, Hagop M.
A2 Wolff, Robert A.
A2 Rieber, Alyssa G.
SR Print(0)
ID 1190832053
T1 Chronic Lymphocytic Leukemia and Associated Disorders
T2 The MD Anderson Manual of Medical Oncology, 4e
YR 2022
FD 2022
PB McGraw Hill Education
PP New York, NY
SN 9781260467642
LK accessmedicine.mhmedical.com/content.aspx?aid=1190832053
RD 2023/03/21
AB KEY  CONCEPTSChronic  lymphocytic  leukemia  (CLL)  is  the  most  common  leukemia  in  the  United  States  and  has  a  median  age  of  diagnosis  of  70  years.The  diagnosis  of  CLL  can  be  established  by  peripheral  blood  flow  cytometry  in  the  majority  of  the  patients.Treatment  of  patients  with  CLL  has  evolved  from  chemoimmunotherapy  (CIT)  to  targeted  therapies.  Most  patients  are  currently  treated  with  oral  targeted  therapies.  Oral  targeted  therapies  include  Bruton  tyrosine  kinase  inhibitors,  B-cell  lymphoma  2  (BCL2)  inhibitors,  and  phosphoinositide  3-kinase  (PI3K)  inhibitors.  Randomized  studies  have  shown  improved  progression-free  survival  (PFS)  and  overall  survival  (OS)  with  oral  targeted  therapies  compared  with  CIT  in  CLL.Targeted  therapies  approved  for  first-line  CLL  include  ibrutinib,  acalabrutinib  +/-  obinutuzumab,  and  venetoclax  +  obinutuzumab.  Ibrutinib  and  acalabrutinib  are  intended  to  be  given  daily  continuously.  Venetoclax  and  obinutuzumab  is  a  time-limited  treatment  approach  of  1-year  duration.In  relapsed  CLL,  the  combination  of  venetoclax  +  rituximab  has  shown  improved  PFS  and  OS  compared  with  bendamustine  and  rituximab.  Additional  approved  therapies  for  relapsed  CLL  include  ibrutinib  and  acalabrutinib.  The  PI3K  inhibitors  idelalisib  and  duvelisib  are  also  approved  for  patients  with  relapsed  CLL.Richter  transformation  remains  an  unmet  medical  need.  ­Outcomes  with  CIT  remains  dismal  with  median  survival  of  less  than  1  year.  There  are  emerging  data  with  checkpoint  inhibition,  use  of  venetoclax-based  combination  therapies,  and  chimeric  antigen  receptor  T-cell  therapy