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International Journal of Hematology
Published in: International Journal of Hematology 5/2020

01-05-2020 | Chronic Lymphocytic Leukemia | Progress in Hematology

Evolution in the management of chronic lymphocytic leukemia in Japan: should MRD negativity be the goal?

Authors: Junji Suzumiya, Jun Takizawa

Published in: International Journal of Hematology | Issue 5/2020

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Abstract

Advances in the molecular biology of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and development of molecularly targeted therapies have resulted in treatment innovations. Therapeutic approaches for previously untreated CLL/SLL patients are changing from chemoimmunotherapy (CIT) to molecularly targeted drugs. The aim of therapy for CLL patients has been to control the disease; however, FCR (fludarabine, cyclophosphamide, rituximab) has improved outcomes and reduced the high incidence of undetectable minimum/measurable residual disease (MRD) in previously untreated CLL patients with no 17p deletion/TP53 disruption and mutated immunoglobulin heavy chain gene (IGHV). Patients achieving undetectable MRD in the bone marrow are expected to be cured. BTK inhibitors and BCL-2 inhibitors are effective for CLL/SLL patients. However, atrial fibrillation and bleeding are associated with the BTK inhibitor, ibrutinib, while tumor lysis syndrome is an adverse event (AE) of the BCL-2 inhibitor, venetoclax. Although these novel targeted drugs are very useful, they are also expensive. Emergence of resistant clones of CLL cells must also be addressed. Therefore, treatments of indefinite duration until progression have been replaced by fixed-duration treatments. This review introduces advances in the treatment of previously untreated CLL/SLL patients in Europe and the United States.
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Metadata
Title
Evolution in the management of chronic lymphocytic leukemia in Japan: should MRD negativity be the goal?
Authors
Junji Suzumiya
Jun Takizawa
Publication date
01-05-2020
Publisher
Springer Nature Singapore
Published in
International Journal of Hematology / Issue 5/2020
Print ISSN: 0925-5710
Electronic ISSN: 1865-3774
DOI
https://doi.org/10.1007/s12185-020-02867-0

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