[Chronic lymphocytic leukemia]

Area of Science:

• Oncology
• Hematology
• Immunology

Background:

• Chronic lymphocytic leukemia (CLL) is a low-grade B cell lymphoma characterized by circulating malignant lymphocytes.
• Diagnosis and treatment guidelines for CLL were updated in 2018, recognizing distinct disease entities based on IGHV mutational status.
• Prognostic factors, including TP53 disruption, are crucial for guiding therapeutic decisions in CLL.

Purpose of the Study:

• To summarize the current understanding of Chronic lymphocytic leukemia (CLL) diagnosis and treatment.
• To highlight the importance of genetic alterations and microenvironment in CLL pathogenesis.
• To review the evolving therapeutic landscape for CLL, including novel agents and chemoimmunotherapy.

Main Methods:

• Review of existing literature on CLL diagnosis, prognosis, and treatment.
• Analysis of genetic alterations and their impact on CLL.
• Evaluation of the role of the microenvironment in CLL progression.
• Comparison of chemoimmunotherapy with novel targeted agents.

Main Results:

• CLL can be stratified into distinct prognostic groups based on IGHV mutational status and TP53 disruption.
• CLL cell dependency on B-cell receptor signaling and microenvironment influences disease progression.
• Patients with CLL exhibit poor vaccine response and are prone to infections, autoimmune disorders, and secondary malignancies.
• Novel drugs like Bruton tyrosine-kinase inhibitors and venetoclax-based regimens show high efficacy, challenging traditional chemoimmunotherapy.

Conclusions:

• Treatment for CLL is not systematic and depends on prognostic markers.
• The microenvironment and genetic landscape significantly impact CLL behavior and progression.
• The therapeutic approach for CLL is rapidly evolving, with targeted therapies offering new hope.
• Future CLL treatment strategies will likely involve combinations of novel agents and chemoimmunotherapy.