对于未经治疗的慢性淋巴细胞白血病选择治疗方法的未解决问题
Rory Bennett1, Mary Ann Anderson1,2,3, John F Seymour4,5
1Department of Clinical Haematology, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, 305 Grattan St, Parkville, Melbourne, VIC, 3000, Australia.
Journal of hematology & oncology
|July 8, 2023
概括
选择最好的慢性淋巴细胞白血病 (CLL) 的初始治疗方法是复杂的. 新型疗法具有优势,但对患者因素和潜在的毒性进行仔细考虑对于有效的治疗顺序至关重要.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 临床治疗学 临床治疗学
背景情况:
- 慢性淋巴细胞白血病 (CLL) 治疗正在迅速发展.
- 选择最佳的第一线治疗需要平衡疾病和患者因素.
- 治疗复发性疾病的治疗顺序是一个关键的临床挑战.
研究的目的:
- 审查关于CLL治疗中未解决问题的当前文献.
- 为最佳使用新疗法提供专家意见.
- 为了指导临床医生在选择和测序CLL疗法.
主要方法:
- 关于当前和临床相关未解决问题的文献评论.
- 讨论可用的相关文献.
- 基于数据分析的专家意见的制定.
主要成果:
- 化疗免疫疗法 (CIT) 的作用正在缩小,但FCR对于IGHV突变的CLL仍然有用.
- 布鲁顿的氨酸激酶抑制剂 (BTKi) 在毒性概况上有所不同.
- 基于Venetoclax的疗法通常优先于连续的BTKi,除了TP53异常CLL.
- 三重疗法显示了与Venetoclax-Obinutuzumab类似的响应率,但不良事件较高.
结论:
- 前线CLL治疗选择必须考虑疗效,患者生物学,并发症和偏好.
- 由于潜在的不良事件和耐药性问题,应谨慎使用新型疗法组合.
- 专家指导对于导航不断变化的CLL治疗环境至关重要.
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