25. Therapy of Chronic Lymphocytic Leukemia: Front-Line and Salvage

  1. Stefan Faderl MD Associate Professor and
  2. Hagop Kantarjian MD Chairman Professor
  1. Valentin Goede MD Resident,
  2. Barbara Eichhorst MD Specialist for Hematology and Oncology and
  3. Michael Hallek MD Director

Published Online: 4 JAN 2011

DOI: 10.1002/9781444327359.ch25

Leukemias: Principles and Practice of Therapy

Leukemias: Principles and Practice of Therapy

How to Cite

Goede, V., Eichhorst, B. and Hallek, M. (2010) Therapy of Chronic Lymphocytic Leukemia: Front-Line and Salvage, in Leukemias: Principles and Practice of Therapy (eds S. Faderl and H. Kantarjian), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444327359.ch25

Editor Information

  1. Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston, TX, USA

Author Information

  1. Department I of Internal Medicine, University Clinic of Cologne, Cologne, Germany

Publication History

  1. Published Online: 4 JAN 2011
  2. Published Print: 26 NOV 2010

ISBN Information

Print ISBN: 9781405182355

Online ISBN: 9781444327359

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Keywords:

  • frontline therapy;
  • salvage therapy;
  • treatment indications;
  • alkylating agents;
  • purine analogs;
  • antibodies;
  • chemoimmunotherapy;
  • minimal residual disease;
  • progression-free survival;
  • overall survival

Summary

During recent years, frontline treatment of chronic lymphocytic leukemia (CLL) has moved from palliative efforts to modern combination therapy that aims to induce durable remissions with subsequent prolongation of life. Fludarabine-based combined chemotherapy is the current standard front-line treatment. However, latest trial results indicate that immunochemotherapy combining cytostatic drugs with monoclonal antibodies is even more active and will become the front-line treatment of choice in the very near future. Frontline therapy of poor-risk patients and of elderly patients is less well defined and needs further exploration. In routine practice, the decision to initiate treatment of primary CLL should depend on clinical criteria. Early front-line therapy in patients presenting with adverse risk factors, as well as consolidation therapy upon response induction, are to be further explored before being incorporated in clinical routine. Salvage therapy of CLL is not yet standardized, and there is a wide spectrum of available regimens. Treatment is only indicated in patients with symptomatic or active recurrent disease. Treatment of minimal residual disease is an experimental approach that should not be applied in routine practice.