New Treatments for Chronic Lymphocytic Lukemia

The treatment landscape for patients with chronic lymphocytic leukemia (CLL) has changedconsiderably with the introduction of very effective oral targeted therapies (such as ibrutinib,idelalisib, and venetoclax), and next-generation anti-CD20 monoclonal antibodies (such asobinutuzumab). These agents lead to improved outcomes in CLL, even among patients with highrisk features, such as del17p13 or TP53 mutation and unmutated immunoglobulin heavy chain(IGHV) genes. Each of these treatments is associated with unique toxicity profile; in the absenceof randomized data, the choice of one type of treatment over another depends on the co-morbiditiesof the patient. Chemoimmunotherapy still plays an important role in the management of previouslyuntreated CLL patients, particularly among young fit patients who have standard risk FISH profileand mutated IGHV genes. Richter’s transformation of CLL remains difficult complication to treat,although therapy with programmed death inhibitors such as pembrolizumab and nivolumab hasshown impressive responses in subset of patients. Our ability to risk stratify CLL patientscontinues to evolve; the CLL-International Prognostic Index (CLL-IPI) is the best validated tool inpredicting time to first therapy among previously untreated patients. This review summarizes thecurrent approach to risk stratification and management of CLL patients.