Current Treatment for Chronic Lymphocytic Leukemia

Within the past 15 years, the management of chronic lymphocytic leukemia (CLL) has shifted from palliative efforts to modern combination therapies that aim to induce durable remissions and prolong life. A widened spectrum of regimens and novel tools to predict response allows for the tailoring of first- and second-line treatment to a patient's individual risk, age, and medical fitness. Herein, we review current treatment indications and therapeutic options, followed by evidence-based recommendations for the choice of therapy in primary and relapsed CLL. Supported by phase III trial data, combined chemotherapy with fludarabine and cyclophosphamide is considered the standard first-line regimen. In all probability, however, chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab will become the standard therapy in the very near future. Patients at poor risk with genetic abnormalities, as well as elderly patients with medical impairments, require special attention because they often do not respond to these novel combination therapies. Salvage therapy (including hematopoietic stem cell transplantation) should be carried out in clinical trials whenever possible because no standard salvage regimen has been defined so far.