[Chronic lymphatic leukemia]

Chronic lymphocytic leukemia of the B-cell type (B-CLL) is the most common type of leukemia. The diagnosis is based on the demonstration of sustained lymphocytosis, bone marrow lymphocytosis and the presence of CD 19/CD5 positive cells. The most important prognostic factor is the stage of the disease (according to RAI or BINET) and the lymphocyte doubling time. Most early stage patients do not benefit from chemotherapy and, indeed, some of these patients never require treatment. Stage A patients with active disease and stage B patients are treated conventionally with chlorambucil/prednisone, but the optimum dosage and duration of chlorambcil treatment has not yet been established. In stage C patients anthracycline containing regimens appear to be more effective. The nucleoside analogues fludarabine and 2-chlorodeoxyadenosine (cladribine) have been shown to be active in patients refractory to alkylating agents. Their role in primary treatment is currently being evaluated in ongoing studies. For a small proportion of patients with advanced disease aged less than 55 years allogeneic or autologous bone marrow transplantation offers the chance of long term remission and possibly even cure, which never can be achieved with conventional chemotherapy.