Therapeutic management of chronic lymphocytic leukaemia: state of the art and future perspectives

Chronic lymphocytic leukaemia (CLL) is a common, often incurable low-grade-B lymphoproliferative disorder. For many years, chlorambucil alone or with steroids has been the drug of choice in treatment-naive patients. Purine nucleoside analogues (PNAs) and, more recently, monoclonal antibodies (i.e. rituximab, alemtuzumab), have increased the potential for obtaining complete or even molecular remissions. Despite these advances, recurrent and/or relapsing disease remains a major concern. In this respect, new clinical and biological agents have recently been identified, which may allow a better selection for high-risk patients, who could be offered more aggressive therapies including haematopoietic stem cell transplantation (HSCT). Although autologous transplant does not appear to provide additional benefit in advanced refractory disease, allogeneic transplant may offer a chance for cure. Non-myeloablative allogeneic transplant probably has curative potential with a better toxicity profile, and it is actively being investigated. We will review the role of the current therapeutic approach to CLL, focusing on the most recent advances in chemoimmunotherapy and haematopoietic stem cell transplantation.