Tremendous improvements in treatment outcome have been obtained over the past decade but for most of the patients chronic lymphocytic leukaemia (CLL) still remains an incurable disease. We eagerly await tools incorporating patient related, disease related and treatment related factors, in order to balance efficacy and toxicity and to personalise treatment in a more rational manner. No treatment is necessary for patients without active and/or advanced disease, regardless of prognostic factors. When treatment is indicated we recommend fludarabine, cyclophosphamide, rituximab (FCR) as front-line strategy for fit patients, bendamustine, rituximab (BR) for patients unfit for FCR and chlorambucil for older patients with a geriatric profile or patients with major comorbidities or a reduced performance status. The choice of treatment for patients with recurrent advanced and/ or active disease depends on the duration of response to the previous treatment and on the type of treatment refractoriness. Reduced intensity conditioning allogeneic stem cell transplantation should be considered for patients with a de novo or an acquired 17p deletion, for patients refractory to F, or F and alemtuzumab, or for patients with an early relapse after chemo-immunotherapy.
We encourage patients to enter clinical trials exploring new agents. Among these new approaches, the signal transduction inhibitors have shown remarkable activity in very advanced disease, independent of genetic aberrations.
(BELG J HEMATOL 2012;3: 134–143)