Novel therapy concepts for chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the western hemisphere and affects mainly elderly and male patients. There is currently no curative approach for advanced symptomatic stages of the disease despite great progress in treatment. Treatment is determined according to patient fitness and comorbidity burden as well as the presence of deletions or mutations in the TP53 gene (very high risk CLL). In physically fit patients without a high comorbidity burden and without very high risk prognostic factors intensive chemotherapy in combination with the CD20 antibody is the standard first line therapy, while in patients with a significant comorbidity burden a less intensive immunochemotherapy regimen is applied. In very high risk patients as well as in patients with relapsed CLL two oral kinase inhibitors, which block the signaling transduction pathway of the B cell receptor have been approved; however, in relapsed CLL repeat administration of immunochemotherapy is still an alternative treatment option, especially if the first remission period was of longer duration (> 24 months). Allogeneic hematopoietic stem cell transplantation can be considered in high risk CLL patients with insufficient response to kinase inhibitors.