Treatment options in chronic lymphocytic leukemia (CLL) – a Polish perspective

• Published in: Journal of health policy & outcomes research no. 1; pp. 20 - 33
• Main Authors: Monica, Magdalena, Władysiuk, Magdalena, Hus, Iwona
• Format: Journal Article
• Language: English
• Published: 08-08-2018
• ISSN: 2299-1247; 2299-1247
• DOI: 10.7365/JHPOR.2018.1.3

Chronic lymphocytic leukemia (CLL) is the most frequent type of leukemia among the elderly people in Western societies. CLL is genetically and molecularly heterogeneous disease that translates into clinical outcomes. Currently, the most unfavorable prognosis is associated with the presence of deletion of the short arm of chromosome 17 (del17p) and/or mutation of the TP53 gene (mTP53) that requires an individualized therapeutic approach. Allogenic hematopoietic stem cells transplantation (allo-HSCT) is still the only potentially curative treatment option in patients with CLL. Nevertheless, it is associated with high toxicity and treatment-related mortality. Therefore, it can be used only in selected patients, mostly young and fit without significant comorbidities. Moreover, allo-HSCT should be performed in patients who achieve disease remission. Recent advances in molecular biology have led to the better understanding of CLL pathophysiology and development of new targeted therapies. Recently developed and approved drugs such as new anti-CD20 monoclonal antibodies (obinutuzumab, ofatumumab), B-cell receptor inhibitors (BCRi) (ibrutinib, idelalisib) and B-cell lymphoma 2 (BCL-2) protein inhibitor (venetoclax) provide better clinical outcomes in CLL patients than previously used standard chemotherapy regimens. Most of those new drugs have been included in treatment algorithms described in Polish, European and global clinical practice guidelines. However, not all of them are available for Polish patients due to the lack of reimbursement, leaving them in the clinical unmet need state. This review summarizes recent advances in CLL treatment, focusing on the Polish perspective.