High-risk chronic lymphocytic leukemia in the era of pathway inhibitors

• Verfasst von: Dreger, Peter [VerfasserIn]
• Titel: High-risk chronic lymphocytic leukemia in the era of pathway inhibitors
• Titelzusatz: integrating molecular and cellular therapies
• Verf.angabe: Peter Dreger, Paolo Ghia, Johannes Schetelig, Michel van Gelder, Eva Kimby, Mauricette Michallet, Carol Moreno, Tadeusz Robak, Stephan Stilgenbauer and Emili Montserrat
• E-Jahr: 2018
• Jahr: 30 August 2018
• Umfang: 11 S.
• Fussnoten: Gesehen am 14.06.2019
• Titel Quelle: Enthalten in: Blood
• Ort Quelle: Washington, DC : American Society of Hematology, 1946
• Jahr Quelle: 2018
• Band/Heft Quelle: 132(2018), 9, Seite 892-902
• ISSN Quelle: 1528-0020
• DOI: doi:10.1182/blood-2018-01-826008
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1667457365

Abstract

Visual Abstract - <img class="highwire-fragment fragment-image" alt="Figure1" src="http://www.bloodjournal.org/content/bloodjournal/132/9/892/F1.medium.gif" width="411" height="440"/>Download figureOpen in new tabDownload powerpoint - - High-risk chronic lymphocytic leukemia (CLL) has been defined by clinical and/or genetic resistance (TP53 abnormalities) to treatment with chemoimmunotherapy (CIT). With the availability of pathway inhibitors (PIs), such as kinase inhibitors and BCL2 antagonists, the outlook of CIT-resistant patients has dramatically improved. Here, we propose a revision of the concept of high-risk CLL, driven by TP53 abnormalities and response to treatment with PI. CLL high-risk-I, CIT-resistant is defined by clinically CIT-resistant disease with TP53 aberrations, but fully responsive to PI. This category is largely the domain of PI-based therapy, and cellular therapy (ie, allogeneic hematopoietic cell transplantation) remains an option only in selected patients with low individual procedure-related risk. In CLL high-risk-II, CIT- and PI-resistant, characterized by increasing exhaustion of pharmacological treatment possibilities, cellular therapies (including chimeric antigen receptor-engineered T cells) should be considered in patients eligible for these procedures. Moreover, molecular and cellular therapies are not mutually exclusive and could be used synergistically to exploit their full potential.