Abstract
The introduction of purine nucleoside analogs, later in combination with alkylating moieties and anti-CD20 immunotherapy, has profoundly improved the response rate and response duration in patients with chronic lymphocytic leukemia (CLL). The quality of clinical response following treatment may be improved to a level where residual leukemic cells become undetectable. As patients with this type of response appear to have extended survival rates, minimal residual disease (MRD) eradication is considered a new objective in CLL treatment with the aim of improving progression-free survival (PFS) and potentially overall survival (OS). This review therefore aims to overview the prognostic value of MRD eradication in CLL, the role of post-remission intervention with "passive" immunotherapy (alemtuzumab or rituximab) so as to eliminate persistent MRD or prevent MRD relapse, the impact of these strategies on disease-free survival and their possible adverse consequences. The data indicate a potential for post-remission alemtuzumab or rituximab to prolong PFS in CLL, although more investigations and longer follow-up are required before MRD-guided strategies can be recommended outside of clinical trials.
MeSH terms
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Agammaglobulinemia / chemically induced
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Alemtuzumab
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Antibodies, Monoclonal, Humanized / adverse effects
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Antibodies, Monoclonal, Humanized / therapeutic use*
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Antibodies, Monoclonal, Murine-Derived / administration & dosage
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Antibodies, Monoclonal, Murine-Derived / adverse effects
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Antibodies, Monoclonal, Murine-Derived / therapeutic use*
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Antigens, CD20 / immunology
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Antineoplastic Agents / therapeutic use*
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Antineoplastic Combined Chemotherapy Protocols / therapeutic use
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Cyclophosphamide / administration & dosage
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Cyclophosphamide / adverse effects
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Cyclophosphamide / therapeutic use*
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Disease-Free Survival
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Humans
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Leukemia, Lymphocytic, Chronic, B-Cell / drug therapy
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Leukemia, Lymphocytic, Chronic, B-Cell / pathology
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Leukemia, Lymphocytic, Chronic, B-Cell / therapy*
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Neoplasm, Residual / drug therapy
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Neutropenia / chemically induced
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Remission Induction
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Rituximab
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Treatment Outcome
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Vidarabine / administration & dosage
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Vidarabine / adverse effects
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Vidarabine / analogs & derivatives*
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Vidarabine / therapeutic use
Substances
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Antibodies, Monoclonal, Humanized
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Antibodies, Monoclonal, Murine-Derived
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Antigens, CD20
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Antineoplastic Agents
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Alemtuzumab
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Rituximab
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Cyclophosphamide
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Vidarabine
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fludarabine