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Therapeutic potential of new B cell-targeted agents in the treatment of elderly and unfit patients with chronic lymphocytic leukemia.

Rai KR - J Hematol Oncol (2015)

Bottom Line: Anti-CD20 monoclonal antibody therapy, which overall has improved response rates and survival in patients with CLL, has only recently been evaluated elderly and unfit patients.B cell-targeted agents such as the Bruton's tyrosine kinase inhibitor ibrutinib and the phosphatidylinositol 3-kinase inhibitor idelalisib are the first of a new generation of oral agents for CLL.Available clinical data suggest that these therapies have the potential to address the unmet need in elderly and unfit patients with CLL and result in clinical remission, and not merely symptom palliation and improved quality of life, which, by themselves, are also a reasonable goal.

View Article: PubMed Central - PubMed

Affiliation: Hofstra North Shore-LIJ School of Medicine and the North Shore-LIJ Cancer Institute, Lake Success, NY, USA. krai@nshs.edu.

ABSTRACT
Chronic lymphocytic leukemia (CLL), the most common adult leukemia in the Western world, is primarily a disease of the elderly, with most patients ≥65 years of age and having at least one major comorbidity. Aggressive chemoimmunotherapy regimens recommended to achieve remission and improve survival in young, fit patients are often poorly tolerated in elderly and/or less physiologically fit ("unfit") patients, necessitating alternative treatment options. Although patient age, fitness, and comorbidities are key considerations in the selection of a treatment regimen, historically, clinical trials have been limited to young, fit patients by virtue of the ethical concerns associated with potential end organ toxic effects that could worsen comorbidities. However, the availability of new therapies promises a shift to a research paradigm that encompasses the identification of optimal treatments for elderly and unfit patients. Anti-CD20 monoclonal antibody therapy, which overall has improved response rates and survival in patients with CLL, has only recently been evaluated elderly and unfit patients. B cell-targeted agents such as the Bruton's tyrosine kinase inhibitor ibrutinib and the phosphatidylinositol 3-kinase inhibitor idelalisib are the first of a new generation of oral agents for CLL. Available clinical data suggest that these therapies have the potential to address the unmet need in elderly and unfit patients with CLL and result in clinical remission, and not merely symptom palliation and improved quality of life, which, by themselves, are also a reasonable goal.

No MeSH data available.


Related in: MedlinePlus

Age-related CLL statistics in the USA. a Percentage of US patients by age at CLL diagnosis, 2009 [6]. b Age-specific incidence rates of CLL, 2007–2011 [7]. CLL chronic lymphocytic leukemia
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Fig1: Age-related CLL statistics in the USA. a Percentage of US patients by age at CLL diagnosis, 2009 [6]. b Age-specific incidence rates of CLL, 2007–2011 [7]. CLL chronic lymphocytic leukemia

Mentions: Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disorder whose clinical features include the abnormal proliferation of mature B cells in peripheral blood, bone marrow, and lymph nodes [1]. It is the most common adult leukemia in the Western world [2]; in the USA, approximately 15,720 new CLL cases and 4600 deaths are expected to have occurred in 2014 [3]. CLL is primarily a disease of the elderly, with a median age at diagnosis of approximately 72 years [4, 5] and nearly 70 % of diagnoses in patients ≥65 years of age (Fig. 1a) [6]. The incidence of CLL increases progressively with each decade in patients >60 years of age (Fig. 1b) [7], and most patients have at least one major comorbidity (Fig. 2) [8].Fig. 1


Therapeutic potential of new B cell-targeted agents in the treatment of elderly and unfit patients with chronic lymphocytic leukemia.

Rai KR - J Hematol Oncol (2015)

Age-related CLL statistics in the USA. a Percentage of US patients by age at CLL diagnosis, 2009 [6]. b Age-specific incidence rates of CLL, 2007–2011 [7]. CLL chronic lymphocytic leukemia
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522086&req=5

Fig1: Age-related CLL statistics in the USA. a Percentage of US patients by age at CLL diagnosis, 2009 [6]. b Age-specific incidence rates of CLL, 2007–2011 [7]. CLL chronic lymphocytic leukemia
Mentions: Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disorder whose clinical features include the abnormal proliferation of mature B cells in peripheral blood, bone marrow, and lymph nodes [1]. It is the most common adult leukemia in the Western world [2]; in the USA, approximately 15,720 new CLL cases and 4600 deaths are expected to have occurred in 2014 [3]. CLL is primarily a disease of the elderly, with a median age at diagnosis of approximately 72 years [4, 5] and nearly 70 % of diagnoses in patients ≥65 years of age (Fig. 1a) [6]. The incidence of CLL increases progressively with each decade in patients >60 years of age (Fig. 1b) [7], and most patients have at least one major comorbidity (Fig. 2) [8].Fig. 1

Bottom Line: Anti-CD20 monoclonal antibody therapy, which overall has improved response rates and survival in patients with CLL, has only recently been evaluated elderly and unfit patients.B cell-targeted agents such as the Bruton's tyrosine kinase inhibitor ibrutinib and the phosphatidylinositol 3-kinase inhibitor idelalisib are the first of a new generation of oral agents for CLL.Available clinical data suggest that these therapies have the potential to address the unmet need in elderly and unfit patients with CLL and result in clinical remission, and not merely symptom palliation and improved quality of life, which, by themselves, are also a reasonable goal.

View Article: PubMed Central - PubMed

Affiliation: Hofstra North Shore-LIJ School of Medicine and the North Shore-LIJ Cancer Institute, Lake Success, NY, USA. krai@nshs.edu.

ABSTRACT
Chronic lymphocytic leukemia (CLL), the most common adult leukemia in the Western world, is primarily a disease of the elderly, with most patients ≥65 years of age and having at least one major comorbidity. Aggressive chemoimmunotherapy regimens recommended to achieve remission and improve survival in young, fit patients are often poorly tolerated in elderly and/or less physiologically fit ("unfit") patients, necessitating alternative treatment options. Although patient age, fitness, and comorbidities are key considerations in the selection of a treatment regimen, historically, clinical trials have been limited to young, fit patients by virtue of the ethical concerns associated with potential end organ toxic effects that could worsen comorbidities. However, the availability of new therapies promises a shift to a research paradigm that encompasses the identification of optimal treatments for elderly and unfit patients. Anti-CD20 monoclonal antibody therapy, which overall has improved response rates and survival in patients with CLL, has only recently been evaluated elderly and unfit patients. B cell-targeted agents such as the Bruton's tyrosine kinase inhibitor ibrutinib and the phosphatidylinositol 3-kinase inhibitor idelalisib are the first of a new generation of oral agents for CLL. Available clinical data suggest that these therapies have the potential to address the unmet need in elderly and unfit patients with CLL and result in clinical remission, and not merely symptom palliation and improved quality of life, which, by themselves, are also a reasonable goal.

No MeSH data available.


Related in: MedlinePlus