Chronic lymphocytic leukemia (CLL) is a low-grade B-lineage lymphoid
malignancy but may have more heterogeneity than previously thought. Many
cases require no treatment at all because of an indolent course, while other
patients become symptomatic or develop signs of rapid progression. Treatment
is usually noncurative and is directed at reducing the symptoms. Some
molecular risk features may help delineate, at initial diagnosis, which
patients will have a more aggressive course. Newer CLL treatment regimens
incorporating purine nucleoside analogues and monoclonal antibodies have
increased the rate of molecular complete remissions, which may lead to
better survival times. Reduced intensity allogeneic transplant conditioning
regimens have made the potentially curative modality more widely available.
All these treatments have significant risks for infectious complications,
which must be carefully weighed against the risks posed by the underlying
disease. A proposed risk-based treatment algorithm is discussed.
Reference:
Oncologist. 2006 Jan;11(1):21-30.
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