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Review
. 2017 Jul;96(7):1185-1196.
doi: 10.1007/s00277-017-2982-1. Epub 2017 Apr 7.

Advances in the treatment of relapsed/refractory chronic lymphocytic leukemia

C Shustik  1 , I Bence-Bruckler  2 , R Delage  3 , C J Owen  4 , C L Toze  5 , S Coutre  6
Affiliations
Review

Advances in the treatment of relapsed/refractory chronic lymphocytic leukemia

C Shustik et al. Ann Hematol. 2017 Jul.

Abstract

Treatment of chronic lymphocytic leukemia (CLL) has advanced with the introduction of chemoimmunotherapy (CIT) agents that have improved the outcomes of frontline therapy. However, most treated patients will relapse and require subsequent therapy. This review focuses on recent advances in the treatment of relapsed or refractory CLL. Until recently, treatment options for relapsed CLL were of limited efficacy. Retreatment with fludarabine, cyclophosphamide, and rituximab (FCR) was recommended for patients with a durable response to first-line FCR, although acquired genetic aberrations, impaired marrow reserve, and comorbidities often made this suboptimal therapy for many patients. New options include two agents targeting B cell receptor (BCR) signaling pathways (ibrutinib and idelalisib) and a B cell lymphoma-2 (BCL-2) inhibitor (venetoclax). Allogeneic hematopoietic stem cell transplantation (HSCT) remains a potentially curative option for younger patients with a suitable donor.

Keywords: CLL; HSCT; Ibrutinib; Idelalisib; Venetoclax.

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Conflict of interest statement

Conflicts of interest

All authors have completed the International Committee of Medical Journal Editors (ICMJE) uniform disclosure at www.icmje.org/coi_disclosure.pdf and declared financial support for the submitted work from Janssen Canada. C. S. has received honoraria for advisory board memberships from Janssen, AbbVie, and Gilead Sciences; I. B.-B. has received honoraria for advisory board memberships from Janssen, Gilead Sciences, and Lundbeck; R. D. has received grants from Roche, Novartis, Janssen, and Pfizer; C. O. has received honoraria for advisory board membership from AbbVie and other honoraria from Janssen and Gilead Sciences; C. T. received grants and/or personal fees for advisory board memberships from Janssen, Lundbeck, Gilead Sciences, and GSK; and S. C. has received honoraria for advisory board memberships from Pharmacyclics, Gilead, and Janssen.

Statement of human and animal rights research

Ethics board approval was obtained from all the three sites in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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