chronic lymphocytic leukemia- recent advances in diagnosis and treatment.docVIP

Chronic Lymphocytic Leukemia: Recent Advances in Diagnosis and Treatment 【关键词】nbsp; CCL,amp;#8226;,Chronic,lymphocytic,leukemia,amp;#8226;,Rituximab,amp;#8226;,ZAP70 　　LEARNING OBJECTIVESnbsp; 　　After completing this course, the reader will be able to: 　　Discuss prognostic markers for CLL, including ZAP70 expression, IgVH rearrangements, and CD38 expression. 　　Describe the latest chemotherapy regimens for CLL, including combinations containing nucleoside analogues and monoclonal antibodies. 　　Describe appropriate indications for initiation of treatment for CLL. 　　ABSTRACTnbsp; nbsp; 　　Chronic lymphocytic leukemia (CLL) is a low-grade B-lineage lymphoid malignancy but may have more heterogeneity than previously thought. Many cases require no treatment at all because of an indolent course, while other patients become symptomatic or develop signs of rapid progression. Treatment is usually noncurative and is directed at reducing the symptoms. Some molecular risk features may help delineate, at initial diagnosis, which patients will have a more aggressive course. Newer CLL treatment regimens incorporating purine nucleoside analogues and monoclonal antibodies have increased the rate of molecular complete remissions, which may lead to better survival times. Reduced intensity allogeneic transplant conditioning regimens have made the potentially curative modality more widely available. All these treatments have significant risks for infectious complications, which must be carefully weighed against the risks posed by the underlying disease. A proposed risk-based treatment algorithm is discussed. 　　 　　DIAGNOSIS AND STAGINGnbsp; nbsp; 　　Chronic lymphocytic leukemia (CLL) is predominantly a disease of older individuals; most patients are older than 50 at the time of initial diagnosis [1, 2]. Furthermore, the disease often has slow progression, so many of these patients ultimately succumb to other medical problems rather than to CLL. Ad