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A canadian perspective on the first-line treatment of chronic lymphocytic leukemia.
- Source :
-
Clinical lymphoma, myeloma & leukemia [Clin Lymphoma Myeloma Leuk] 2015 Jun; Vol. 15 (6), pp. 303-13. Date of Electronic Publication: 2015 Mar 26. - Publication Year :
- 2015
-
Abstract
- Despite important advances in the treatment of first-line chronic lymphocytic leukemia (CLL) over the past decade, CLL remains an incurable disease with significant unmet needs. The combination of rituximab with fludarabine and cyclophosphamide (FCR) significantly improved overall survival and progression-free survival compared with fludarabine and cyclophosphamide alone in first-line treatment of CLL. However, because of its high toxicity, FCR is only recommended for younger, fit patients who can tolerate the treatment. This excludes a large fraction of CLL patients who are elderly and/or who have comorbidities. Thus, determining the appropriate treatment choices for this group of patients who are unfit for FCR treatment is a significant challenge in CLL. Current treatment choices in Canadian practice include bendamustine with rituximab, fludarabine with rituximab, and chlorambucil with rituximab. Two novel monoclonal antibodies, ofatumumab and obinutuzumab, have also recently received Health Canada approval for the first-line treatment of CLL patients in combination with chlorambucil. In addition, the Bruton tyrosine kinase inhibitor, ibrutinib, has recently been approved by Health Canada for the first-line treatment of CLL patients with deletion 17p. In the coming years, several other novel agents that are being developed are likely to change the CLL treatment landscape dramatically, however, because these novel agents are currently unavailable, the purpose of this review is to recommend the best treatment approaches in Canada using currently available therapies.<br /> (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Subjects :
- Adenine analogs & derivatives
Alemtuzumab
Antibodies, Monoclonal administration & dosage
Antibodies, Monoclonal, Humanized administration & dosage
Antineoplastic Combined Chemotherapy Protocols adverse effects
Bendamustine Hydrochloride administration & dosage
Canada
Chlorambucil administration & dosage
Cyclophosphamide administration & dosage
Humans
Leukemia, Lymphocytic, Chronic, B-Cell genetics
Piperidines
Pyrazoles administration & dosage
Pyrimidines administration & dosage
Rituximab administration & dosage
Vidarabine administration & dosage
Vidarabine analogs & derivatives
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Leukemia, Lymphocytic, Chronic, B-Cell drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2152-2669
- Volume :
- 15
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Clinical lymphoma, myeloma & leukemia
- Publication Type :
- Academic Journal
- Accession number :
- 25937158
- Full Text :
- https://doi.org/10.1016/j.clml.2015.03.002