From the Guidelines
Chronic Lymphocytic Leukemia (CLL) is a type of leukemia, specifically a slow-growing cancer that affects white blood cells called lymphocytes in the bone marrow, and it is the most common type of leukemia in adults, primarily affecting older individuals. CLL is characterized by the accumulation of small, mature-appearing lymphocytes in the blood, bone marrow, and lymphoid tissues. Unlike acute leukemias, CLL typically progresses slowly, and many patients don't require immediate treatment. The disease begins in B lymphocytes, which normally help fight infection by producing antibodies. In CLL, these abnormal B cells accumulate and crowd out healthy blood cells, leading to decreased immunity, anemia, and platelet deficiencies.
Some key points to consider in the management of CLL include:
- The importance of assessing the patient's age, overall health, and genetic factors like deletion 17p or TP53 mutations in determining the best course of treatment 1.
- The use of chemotherapy regimens like FCR (fludarabine, cyclophosphicide, rituximab), targeted therapies such as BTK inhibitors (ibrutinib, acalabrutinib), BCL-2 inhibitors (venetoclax), and monoclonal antibodies (rituximab, obinutuzumab) as treatment options 1.
- The role of measurable residual disease (MRD) in predicting patient outcomes and guiding treatment decisions 1.
- The potential for histologic transformation to more aggressive lymphomas, such as diffuse large B-cell lymphoma (DLBCL) or Hodgkin lymphoma (HL), which can significantly impact patient outcomes 1.
Treatment decisions should be based on the patient's individual characteristics, including their age, overall health, and genetic factors, as well as the presence of measurable residual disease. While CLL is generally not curable outside of stem cell transplantation, many patients can live for years or decades with appropriate management. It is essential to consider the latest evidence and guidelines when making treatment decisions, including the recommendations outlined in the NCCN Guidelines for the diagnosis and management of patients with CLL/SLL 1.
From the Research
Definition and Diagnosis of Chronic Lymphocytic Leukemia (CLL)
- Chronic lymphocytic leukemia (CLL) is defined as a type of leukemia that typically occurs in older patients and has a highly variable clinical course 2.
- The diagnosis of CLL is established by blood counts, blood smears, and immunophenotyping of circulating B-lymphocytes, which identify a clonal B-cell population carrying the CD5 antigen as well as typical B-cell markers 2.
- CLL and small lymphocytic lymphoma (SLL) are considered the same disease with different presentations, and should be treated the same way 3.
Relationship between CLL and Leukemia
- CLL is the most frequent type of leukemia, and is characterized by the uncontrolled proliferation of mature lymphocytes 2, 4.
- Leukemic transformation in CLL is initiated by specific genomic alterations that interfere with the regulation of proliferation and apoptosis in clonal B-cells 2.
- CLL is a heterogeneous disease, and a subset of patients with complex karyotype presents with poor prognosis and limited treatment options 4.
Treatment and Management of CLL
- Treatment of CLL should be initiated in symptomatic patients with criteria for active disease, and should prioritize targeted therapies over immunochemotherapy 3.
- Various treatment options are available, including combinations of BCL2 inhibitors with obinutuzumab or ibrutinib, or monotherapy with inhibitors of Bruton tyrosine kinase (BTK) 2, 5.
- The choice of treatment should be individualized, considering factors such as patient fitness, comorbidities, and potential toxicities 3, 6.
- Emerging therapies, including novel oral agents and combination therapies, are being studied and may improve outcomes in patients with CLL 5, 6, 4.