Therapy of chronic lymphocytic leukaemia

Rapid progress has been achieved recently in the management of chronic lymphocytic leukaemia (CLL). New insights into the molecular pathology of CLL have generated a plethora of biological markers that predict the prognosis and influence therapeutic decisions. Moreover, fludarabine, bendamustine and two monoclonal antibodies, alemtuzumab and rituximab, have been approved by European and/or American regulatory agencies. Additional monoclonal antibodies targeting CD20, CD23, CD37, CD38 or CD40, as well as drugs designed to interfere with proteins regulating the cell cycle, apoptotic machinery or leukaemic microenvironment (e.g., flavopiridol, oblimersen, ABT-263 or lenalidomide) are investigated in clinical trials. An increased experience with reduced-intensity allogeneic progenitor cell transplantation allows offering this option to physically fit patients. This review attempts to summarise the current use of these different modalities in CLL therapy.