The up-to-date role of biologics for the treatment of chronic lymphocytic leukemia

Abstract

Introduction: Chronic lymphocytic leukemia (CLL) is a genetically complex disease that affects a heterogeneous patient population. Therapeutic armamentarium of CLL has changed recently following the introduction of novel active agents.

Areas covered: This review presents the current state of knowledge about biologic drugs used in the treatment of patients with CLL. It also discusses the biologics under evaluation in clinical trials and their potential future perspectives. A literature review of the MEDLINE database for articles was conducted via PubMed. Publications from 2000 through October 2019 were scrutinized using the search terms monoclonal antibodies, alloHSCT, vaccines and CAR-T in conjunction with CLL. Conference proceedings from the previous five years of the ASH and EHA Annual Scientific Meetings were searched manually. Additional relevant publications were obtained by reviewing the references from the chosen articles.

Expert opinion: When used in combination with chemotherapy and, more recently, with the Bcl-2 inhibitor venetoclax, anti-CD20 monoclonal antibodies (mAbs) are among the standard methods used for CLL treatment. Among the new mAbs, anti-ROR1 directed cirmtuzumab seems to have the most promising results. Adoptive immunotherapy with CAR-T is an area of intensive research, giving hope for achieving remission in patients with CLL refractory to all other methods of treatment.

Keywords: Chronic lymphocytic leukemia; allogeneic hematopietic stem cell transplantation; biologics; chimeric antigen receptor T-cells; monoclonal antibodies; vaccines.