Therapeutic Approach to Patients with Chronic Lymphocytic Leukemia and Significant Comorbid Conditions

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00179906%3A_____%2F16%3A10329428" target="_blank" >RIV/00179906:_____/16:10329428 - isvavai.cz</a>

Alternative codes found

RIV/00216208:11150/16:10329428

Result on the web

<a href="http://dx.doi.org/10.2174/1568009616666160408145850" target="_blank" >http://dx.doi.org/10.2174/1568009616666160408145850</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.2174/1568009616666160408145850" target="_blank" >10.2174/1568009616666160408145850</a>

Result language

angličtina

Original language name

Therapeutic Approach to Patients with Chronic Lymphocytic Leukemia and Significant Comorbid Conditions

Original language description

Clinical trials in chronic lymphocytic leukemia (CLL) have focused mainly on younger fit patients until recently. However, CLL is a disease of elderly and many patients have significant comorbid conditions which together with advanced age preclude the use of aggressive regimens like FCR (fludarabine, cyclophosphamide, rituximab). Therefore, parameters such as performance status, renal function and number/severity of comorbidities together with clinical judgment should be used to guide the decision-making process regarding intensity of treatment. Two large randomized trials recently demonstrated that addition of monoclonal anti-CD20 antibodies (obinutuzumab, rituximab, and ofatumumab) to chlorambucil in untreated comorbid patients lead to improvement in complete remission rate, progression-free survival and even overall survival (obinutuzumab-chlorambucil and rituximab-chlorambucil), with acceptable toxicity profile. Thus, chemoimmunotherapy combining chlorambucil with an anti-CD20 antibody is the new standard approach for elderly/comorbid CLL patients in the first line. Treatment of relapsed/refractory disease in this patient population is very challenging and data regarding this subpopulation are rather limited. Impressive efficacy of novel targeted small molecules interfering with B-cell receptor signaling, namely Bruton tyrosine kinase inhibitor ibrutinib and phosphatidylinositol-3 kinase delta inhibitor idelalisib, radically changed the treatment paradigms for relapsed/refractory CLL; relatively mild toxicity of these agents make them very good candidates for elderly/comorbid patients. Other options for relapsed/refractory disease include alemtuzumab, ofatumumab, high-dose glucocorticoids+rituximab and bendamustine+rituximab. This review summarizes the current knowledge on prognostication and therapy of elderly and comorbid patients with CLL.

Czech name

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Czech description

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Type

J_x - Unclassified - Peer-reviewed scientific article (Jimp, Jsc and Jost)

CEP classification

FD - Oncology and haematology

OECD FORD branch

—

Project

<a href="/en/project/NT13412" target="_blank" >NT13412: Complex assessment of microenvironment and its impact on clinical course of chronic lymphocytic leukemia.</a><br>

Continuities

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)<br>I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Publication year

2016

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Current Cancer Drug Targets

ISSN

1568-0096

e-ISSN

—

Volume of the periodical

16

Issue of the periodical within the volume

8

Country of publishing house

AE - UNITED ARAB EMIRATES

Number of pages

11

Pages from-to

710-720

UT code for WoS article

000387003900007

EID of the result in the Scopus database

2-s2.0-84989225454