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Review
. 2018 Nov 30;2018(1):242-247.
doi: 10.1182/asheducation-2018.1.242.

Selecting Frontline Therapy for CLL in 2018

Nitin Jain  1
Affiliations
Review

Selecting Frontline Therapy for CLL in 2018

Nitin Jain. Hematology Am Soc Hematol Educ Program. .

Abstract

The treatment landscape of chronic lymphocytic leukemia (CLL) has changed dramatically in the last few years. The role of chemoimmunotherapy has declined significantly for patients with CLL. Fludarabine, cyclophosphamide, rituximab chemotherapy remains the standard frontline therapy for young fit patients with CLL, especially if IGHV mutated. For older adults, ibrutinib has been shown to be superior to chlorambucil. Hence, the role of chlorambucil monotherapy in the current era in the management of CLL is limited. The combination of chlorambucil and obinutuzumab is an alternative option for patients with comorbidities. For patients with del(17p), ibrutinib has become the standard treatment in the frontline setting. Several phase 3 trials with novel targeted agents, either as monotherapy or in combination, are either ongoing or have completed accrual. The results of many of these trials are expected in the next 1 to 2 years, and they will further help refine the frontline treatment strategy.

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Conflict of interest statement

Conflict-of-interest disclosure: N.J. has received research funding from Pharmacyclics, Abbvie, Genentech, Verastem, BMS, and AstraZaneca and has received honoraria from Pharmacyclics, Abbvie, AstraZaneca, Adaptive Biotechnologies, Verastem, and Janssen.

Figures

Figure 1.
Figure 1.
Selection of frontline therapy for CLL. *BR is preferred over FCR for patients with moderate renal dysfunction and patients 65 years or older who are deemed appropriate for FCR therapy. Cbl, chlorambucil; FISH, fluorescence in situ hybridization; IWCLL, International Workshop on Chronic Lymphocytic Leukemia.
See this image and copyright information in PMC

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