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新型靶向治疗时代慢性淋巴细胞白血病的治疗策略

[Treatment strategies for chronic lymphocytic leukemia in the era of novel targeted therapies].

作者信息

Kojima Kensuke

机构信息

Department of Hematology, Kochi Medical School, Kochi University.

出版信息

Rinsho Ketsueki. 2020;61(9):1275-1280. doi: 10.11406/rinketsu.61.1275.

Abstract

Molecular targeted therapies with small molecule inhibitors and antibodies have rapidly replaced chemoimmunotherapy, which has been the gold standard of care for patients with chronic lymphocytic leukemia (CLL). We discuss the current treatment strategies for CLL with special emphasis on genomic and molecular risk factors including IGHV unmutated status, 11q deletion, and 17p deletion. Ibrutinib and venetoclax are two molecular targeted agents currently available in Japan. They are highly effective, well tolerated, and have improved overall survival. Therefore, molecular targeted therapies are preferred to chemoimmunotherapy for most patients. Ongoing studies will clarify the optimal option between combination and sequence of treatment regimens with an appropriate timing of therapeutic intervention for longer survival. We are nearing an era of chemotherapy-free CLL management.

摘要

小分子抑制剂和抗体的分子靶向疗法已迅速取代了化学免疫疗法,而化学免疫疗法一直是慢性淋巴细胞白血病(CLL)患者的护理金标准。我们讨论了CLL的当前治疗策略,特别强调了基因组和分子危险因素,包括IGHV未突变状态、11q缺失和17p缺失。伊布替尼和维奈克拉是目前在日本可用的两种分子靶向药物。它们高效、耐受性良好,并提高了总生存率。因此,对于大多数患者而言,分子靶向疗法优于化学免疫疗法。正在进行的研究将阐明治疗方案联合使用和序贯治疗的最佳选择,以及进行适当治疗干预的时机,以实现更长的生存期。我们正迈向量化无化疗的CLL管理时代。

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