A Canadian Perspective on the First-Line Treatment of Chronic Lymphocytic Leukemia
Autor: | Inès Chamakhi, Cynthia L. Toze, Anna Christofides, Wissam Assaily, Susan A. Robinson, Carolyn Owen, Isabelle Bence-Bruckler |
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Rok vydání: | 2015 |
Předmět: |
Bendamustine
Oncology Canada Cancer Research medicine.medical_specialty Chronic lymphocytic leukemia Antibodies Monoclonal Humanized Ofatumumab chemistry.chemical_compound Piperidines immune system diseases Obinutuzumab hemic and lymphatic diseases Internal medicine Antineoplastic Combined Chemotherapy Protocols Bendamustine Hydrochloride Humans Medicine Alemtuzumab Cyclophosphamide Chlorambucil business.industry Adenine Antibodies Monoclonal Hematology medicine.disease Leukemia Lymphocytic Chronic B-Cell Fludarabine Pyrimidines chemistry Ibrutinib Immunology Pyrazoles Rituximab business Vidarabine medicine.drug |
Zdroj: | Clinical Lymphoma Myeloma and Leukemia. 15:303-313 |
ISSN: | 2152-2650 |
Popis: | 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. |
Databáze: | OpenAIRE |
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