A krónikus lymphoid leukaemiával kapcsolatos ismereteink jelentősen bővültek. A hagyományos és a biológiai prognosztikai tényezőknek köszönhetően lehetővé vált a várható prognózis pontosabb megállapítása. A terápia fejlődése elsősorban a fludarabin és monoklonális antitestek elterjedésének köszönhető. A kemoimmunoterápiával nemcsak a remisszió aránya, hanem a betegek túlélése is javult. A komplett hematológiai remisszió nagyarányú elérése és a residualis leukaemia eliminálása a gyógyulás potenciális feltételeit is megteremtette. A jelentős fejlődés ellenére számos kérdés merül fel a klinikai gyakorlatban. A szerzők az irodalom és saját tapasztalataik alapján áttekintik a krónikus lymphoid leukaemia kezelésének lehetőségeit. Orv. Hetil., 2011, 152, 958–963.
Gribben, J. G.: How I treat CLL up front. Blood, 2010, 115, 187–197.
Gribben J. G. , 'How I treat CLL up front ' (2010 ) 115 Blood : 187 -197 .
Hallek, M., Cheson, B. D., Catovsky, D. és mtsai: Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute – Working Group 1996 guidelines. Blood, 2008, 111, 5446–5456.
Catovsky D. , 'Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute – Working Group 1996 guidelines ' (2008 ) 111 Blood : 5446 -5456 .
Leporrier, M., Chevret, S., Cazin, B. és mtsai: Randomized comparison of fludarabine, CAP, and ChOP in 938 previously untreated stage B and C chronic lymphocytic leukemia patients. Blood, 2001, 98, 2319–2325.
Cazin B. , 'Randomized comparison of fludarabine, CAP, and ChOP in 938 previously untreated stage B and C chronic lymphocytic leukemia patients ' (2001 ) 98 Blood : 2319 -2325 .
Rai, K. R., Peterson, B. L., Appelbaum, F. R. és mtsai: Fludarabine compared with chlorambucil as primary therapy for chronic lymphocytic leukemia. N. Engl. J. Med., 2000, 343, 1750–1757.
Appelbaum F. R. , 'Fludarabine compared with chlorambucil as primary therapy for chronic lymphocytic leukemia ' (2000 ) 343 N. Engl. J. Med. : 1750 -1757 .
Rai, K. R., Peterson, B. L., Appelbaum, F. R. és mtsai, Long-term survival analysis of the North American Intergroup Study: (F) and chlorambucil (C) in previously untreated patients with chronic lymphocytic leukemia (CLL). Blood (ASH Annual Meeting Abstracts), 2009, 114, Abstract 536.
Appelbaum F. R. , 'Long-term survival analysis of the North American Intergroup Study C9011 comparing fludarabine (F) and chlorambucil (C) in previously untreated patients with chronic lymphocytic leukemia (CLL) ' (2009 ) 114 Blood (ASH Annual Meeting Abstracts) : Abstract 536 -.
Hallek, M., Eichhorst, B. F.: Chemotherapy combination treatment regimens with fludarabine in chronic lymphocytic leukemia. Hematol. J., 2004, 5, (Suppl. 1), S20–30.
Eichhorst B. F. , 'Chemotherapy combination treatment regimens with fludarabine in chronic lymphocytic leukemia ' (2004 ) 5 Hematol. J. : (Suppl. 1), S20 -30 .
Tam, C. S., O’Brien, S., Wierda, W. és mtsai: Long-term results of the fludarabine, cyclophosphamide, and rituximab regimen as initial therapy of chronic lymphocytic leukemia. Blood, 2008, 112, 975–980.
Wierda W. , 'Long-term results of the fludarabine, cyclophosphamide, and rituximab regimen as initial therapy of chronic lymphocytic leukemia ' (2008 ) 112 Blood : 975 -980 .
Hallek, M., Fischer, K., Fingerle-Rowson, G. és mtsai: Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open label, phase 3 trial. Lancet, 2010, 376, 1164–1174.
Fingerle-Rowson G. , 'Addition of rituximab to fludarabine and cyclophosphamide in patients with chronic lymphocytic leukaemia: a randomised, open label, phase 3 trial ' (2010 ) 376 Lancet : 1164 -1174 .
Abrisqueta, P., Pereira, A., Rozman, C. és mtsai: Improving survival in patients with chronic lymphocytic leukemia (1980–2008): the Hospital Clinic of Barcelona experience. Blood, 2009, 114, 2044–2050.
Rozman C. , 'Improving survival in patients with chronic lymphocytic leukemia (1980–2008): the Hospital Clinic of Barcelona experience ' (2009 ) 114 Blood : 2044 -2050 .
Thurmes, P., Call, T., Slager, S. és mtsai: Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia. Leuk. Lymph., 2008, 49, 49–56.
Slager S. , 'Comorbid conditions and survival in unselected, newly diagnosed patients with chronic lymphocytic leukemia ' (2008 ) 49 Leuk. Lymph. : 49 -56 .
Losonczy H.: Idült lymphoid leukaemia (CLL). In: Hematológiai betegségek kezelése. Szerk.: Lehoczky D. Documed Kft., Budapest, 2006, 93–106.
Losonczy H. , '', in Hematológiai betegségek kezelése , (2006 ) -.
Hallek, M.: State-of-the-art treatment of chronic lymphocytic leukemia. Hematology/ASH Education Program Book, 2009, 440–449.
Hillmen, P.: Risk adapted chronic lymphocytic leukemia management. Hematology education: the education program for the annual congress of the European Hematology Association, 2009, 3, 68–71, Berlin.
Hallek, M.: Therapy of chronic lymphocytic leukaemia. Best Practice Res. Clin. Haematol., 2010, 23, 85–96.
Hallek M. , 'Therapy of chronic lymphocytic leukaemia ' (2010 ) 23 Best Practice Res. Clin. Haematol. : 85 -96 .
Foon, K. A., Boyiadzis, M., Land, S. R. és mtsai: Chemoimmunotherapy with low-dose fludarabine and cyclophosphamide and high dose rituximab in previously untreated patients with chronic lymphocytic leukemia. J. Clin. Oncol., 2009, 27, 498–503.
Land S. R. , 'Chemoimmunotherapy with low-dose fludarabine and cyclophosphamide and high dose rituximab in previously untreated patients with chronic lymphocytic leukemia ' (2009 ) 27 J. Clin. Oncol. : 498 -503 .
Telek B., Batár P., Rejtő L. és mtsa: B-sejtes prolymphocytás leukaemia (B-PLL) sikeres kezelése FCR-Lite (fludarabin, cyclophophamid, rituximab) protokoll alkalmazásával. Orv. Hetil., 2010, 151, 1261–1263.
Rejtő L. , 'B-sejtes prolymphocytás leukaemia (B-PLL) sikeres kezelése FCR-Lite (fludarabin, cyclophophamid, rituximab) protokoll alkalmazásával ' (2010 ) 151 Orv. Hetil. : 1261 -1263 .
Fischer, K., Cramer, P., Stilgenbauer, S. és mtsai: Bendamustine combined with rituximab (BR) in fi rst-line therapy of advanced CLL: a multicenter phase II trial of the German CLL Study Group (GCLLSG). Blood (ASH Annual Meeting Abstracts), 2009, 114, Abstract 205.
Stilgenbauer S. , 'Bendamustine combined with rituximab (BR) in first-line therapy of advanced CLL: a multicenter phase II trial of the German CLL Study Group (GCLLSG) ' (2009 ) 114 Blood (ASH Annual Meeting Abstracts) : Abstract 205 -.
Dennie, T. W., Kolesar, J. M.: Bendamustine for the treatment of chronic lymphocytic leukemia and rituximab-refractory, indolent B-cell non-Hodgkin lymphoma. Clin. Ther., 2009, 31, 2290–2311.
Kolesar J. M. , 'Bendamustine for the treatment of chronic lymphocytic leukemia and rituximab-refractory, indolent B-cell non-Hodgkin lymphoma ' (2009 ) 31 Clin. Ther. : 2290 -2311 .
Pönisch, W., Rozanski, M., Goldschmidt, H. és mtsai: Combined bendamustine, prednisone and thalidomide for refractory or relapsed multiple myeloma after autologous stem-cell transplantation or conventional chemotherapy: results of a Phase I clinical trial. Brit. J. Haematol., 2008, 143, 191–200.
Goldschmidt H. , 'Combined bendamustine, prednisone and thalidomide for refractory or relapsed multiple myeloma after autologous stem-cell transplantation or conventional chemotherapy: results of a Phase I clinical trial ' (2008 ) 143 Brit. J. Haematol. : 191 -200 .
Jurlander, J.: Prognostic marker in chronic lymphocytic leukemia. Hematology education: the education program for the annual congress of the European Hematology Association, 2008, 2, 308–313, Copenhagen.
Pettitt, A. R.: Genetic markers of prognosis in chronic lymphocytic leukemia. Hematology education: the education program for the annual congress of the European Hematology Association, 2010, 4, 85–92, Barcelona.
Lundin, J., Kimby, E., Bjorkholm, M. és mtsai: Phase II trial of subcutaneous anti-CD52 monoclonal antibody alemtuzumab (Campath-1H) as first-line treatment for patients with B-cell chronic lymphocytic leukemia (B-CLL). Blood, 2002, 100, 768–773.
Bjorkholm M. , 'Phase II trial of subcutaneous anti-CD52 monoclonal antibody alemtuzumab (Campath-1H) as first-line treatment for patients with B-cell chronic lymphocytic leukemia (B-CLL) ' (2002 ) 100 Blood : 768 -773 .
Hillmen, P., Skolnicki, A. B., Robak, T. és mtsai: Alemtuzumab compared with chlorambucil as first-line therapy for chronic lymphocytic leukemia. J. Clin. Oncol., 2007, 25, 5616–5623.
Robak T. , 'Alemtuzumab compared with chlorambucil as first-line therapy for chronic lymphocytic leukemia ' (2007 ) 25 J. Clin. Oncol. : 5616 -5623 .
Parikh, S. A., Keating, M., O’Brieen, S. és mtsai: Frontline combined chemoimmunotherapy with fl udarabine, cyclophosphamide, alemtuzumab and rituximab (CFAR) in high-risk chronic lymphocytic leukemia. Blood (ASH Annual Meeting Abstracts), 2009, 114, Abstract 208.
O’Brieen S. , 'Frontline combined chemoimmunotherapy with fl udarabine, cyclophosphamide, alemtuzumab and rituximab (CFAR) in high-risk chronic lymphocytic leukemia ' (2009 ) 114 Blood (ASH Annual Meeting Abstracts) : Abstract 208 -.
Österborg, A., Foa, R., Bezares, R. F. és mtsai: Management guidelines for the use of alemtuzumab in chronic lymphocytic leukemia. Leukemia, 2009, 23, 1980–1988.
Bezares R. F. , 'Management guidelines for the use of alemtuzumab in chronic lymphocytic leukemia ' (2009 ) 23 Leukemia : 1980 -1988 .
Eichhorst, B. F., Busch, R., Hopfinger, G. és mtsai: Fludarabine plus cyclophosphamide versus fludarabine alone in first line therapy of younger patients with chronic lymphocytic leukemia. Blood, 2006, 107, 885–891.
Hopfinger G. , 'Fludarabine plus cyclophosphamide versus fludarabine alone in first line therapy of younger patients with chronic lymphocytic leukemia ' (2006 ) 107 Blood : 885 -891 .
Catovsky, D., Richards, S., Matutes, E. és mtsai: Assessment of fludarabine plus cyclophosphamide for patients with chronic lymphocytic leukemia (the LRFCLL4 Trial): a randomised controlled trial. Lancet, 2007, 370, 230–239.
Matutes E. , 'Assessment of fludarabine plus cyclophosphamide for patients with chronic lymphocytic leukemia (the LRFCLL4 Trial): a randomised controlled trial ' (2007 ) 370 Lancet : 230 -239 .
Flinn, I. W., Neuberg, D. S., Grever, M. R. és mtsai: Phase III trial of fludarabine plus cyclophosphamide compared with fludarabine for patients with previously untreated chronic lymphocytic leukemia. US Intergroup Trial E2997. J. Clin. Oncol., 2007, 25, 793–798.
Grever M. R. , 'Phase III trial of fludarabine plus cyclophosphamide compared with fludarabine for patients with previously untreated chronic lymphocytic leukemia. US Intergroup Trial E2997 ' (2007 ) 25 J. Clin. Oncol. : 793 -798 .
Knauf, W. U., Lissichkov, T., Aldaoud, A. és mtsai: Bendamustine versus chlorambucil in treatment naive patients with B-cell chronic lymphocytic leukemia (B-CLL): results of an international phase III study. Blood (ASH Annual Meeting Abstracts), 2007, 110, Abstract 2043.
Aldaoud A. , 'Bendamustine versus chlorambucil in treatment naive patients with B-cell chronic lymphocytic leukemia (B-CLL): results of an international phase III study ' (2007 ) 110 Blood (ASH Annual Meeting Abstracts) : Abstract 2043 -.
Eichorst, B. F., Busch, R., Stigenbauer, S. és mtsai: First-line therapy with fludarabine compared with chlorambucil does not result in a major benefit for elderly patients with advanced chronic lymphocytic leukemia. Blood, 2009, 114, 3382–3391.
Stigenbauer S. , 'First-line therapy with fludarabine compared with chlorambucil does not result in a major benefit for elderly patients with advanced chronic lymphocytic leukemia ' (2009 ) 114 Blood : 3382 -3391 .
Montserrat, E., Moreno, C., Esteve, J. és mtsai: How I treat refractory CLL. Blood, 2006, 107, 1276–1283.
Esteve J. , 'How I treat refractory CLL ' (2006 ) 107 Blood : 1276 -1283 .
Keating, M. J., Flinn, I., Jain, V. és mtsai: Therapeutic role of alemtuzumab (Campath-IH) in patients who have failed fludarabine: results of a large international study. Blood, 2002, 99, 3554–3561.
Jain V. , 'Therapeutic role of alemtuzumab (Campath-IH) in patients who have failed fludarabine: results of a large international study ' (2002 ) 99 Blood : 3554 -3561 .
Marti, G. E., Mo, C., Stetler-Stevenson, M. A. és mtsai: Is eradication of MRD feasible and worthwhile in CLL? The 1st world congress on controversies in hematology, A-12, 2010, Rome.
Wierda, W. G., Kipps, T. J., Dürig, J. és mtsai: Ofatumumab combined with fludarabine and cyclophosphamide (O-FC) shows high activity in patients with previously untreated chronic lymphocytic leukemia (CLL): results from a randomized, multicenter, international, two-dose, parallel group, phase II. trial. Blood (ASH Annual Meeting Abstracts), 2009, 114, Abstract 207.
Dürig J. , 'Ofatumumab combined with fludarabine and cyclophosphamide (O-FC) shows high activity in patients with previously untreated chronic lymphocytic leukemia (CLL): results from a randomized, multicenter, international, two-dose, parallel group, phase II. trial ' (2009 ) 114 Blood (ASH Annual Meeting Abstracts) : Abstract 207 -.
Lin, T. S.: New agents in chronic lymphocytic leukemia. Curr. Hematol. Malig. Rep., 2010, 5, 29–34.
Lin T. S. , 'New agents in chronic lymphocytic leukemia ' (2010 ) 5 Curr. Hematol. Malig. Rep. : 29 -34 .
Bazargan, A., Tam, C. S.: New angels of attack in the fight against chronic lymphocytic leukemia: the advent of novel non-chemotherapeutic agents. Leuk. Lymphom., 2010, 51, 1596–1611.
Tam C. S. , 'New angels of attack in the fight against chronic lymphocytic leukemia: the advent of novel non-chemotherapeutic agents ' (2010 ) 51 Leuk. Lymphom. : 1596 -1611 .