Milestones in Chronic Lymphocytic LeukemiaAn exciting decade of progress—10th anniversary of memo

摘要

The past 10 years have been an exciting ride for Chronic Lymphocytic Leukemia (CLL) aficionados. An overview of changes in management paradigms in CLL, ranging from insights into biology, via chemotherapy and chemoimmunotherapy to maintenance and novel drugs will be presented. The 10 year anniversary of a journal is not only a reason for celebration, but also provides an opportunity to assess progress in the field over a longer period of time. In our clinical world of incremental improvements, this is a relatively rare opportunity to reflect on what has happened on a larger scale than usual and determine how happy or hopeful that leaves us. About 10 years ago, the CLL field had just left the stage where CLL was treated with chlorambucil (CLB) monotherapy or lymphoma polychemotherapy with limited success for the aggressive variants of CLL for decades. Resurrecting CLL from being the "boring" leukemia, the field developed very relevant dynamics ([1]; Fig. 1). At the turn of the millennium, important biological insights, such as the recognition of recurrent FISH cytogenetic lesions [2], which had a very relevant prognostic impact, or the definition of two biologically distinct groups of CLL, i. e., those with mutated and unmutated IgVH status [3, 4] and again very different clinical behavior, were gained. Also, more effective chemotherapy backbones were proposed and a combination of fludarabine and cyclophosphamide (FC) had been shown to produce better responses and longer PFS in a number of randomized trials [5, 6]. However, none of these trials produced anoverall survival (OS) benefit.