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Aktuelle Therapiestrategien zur chronischen lymphatischen Leukämie

  • Petra LangerbeinsEmail author
  • Barbara Eichhorst
  • Michael Hallek
Leitthema
  • 16 Downloads

Zusammenfassung

Durch die Erforschung der Signalwege von B‑Lymphozyten und die Identifizierung von beteiligten Kinasen konnten viele neue, zielgerichtete Therapien entwickelt werden. Am weitesten und besten erforscht sind die Kinaseinhibitoren Ibrutinib und Idelalisib sowie der BCL2-Inhibitor Venetoclax. Zahlreiche prognostische und prädiktive Biomarker stehen zur Verfügung. Die Auswahl der Erstlinientherapie orientiert sich am TP53-Status, dem IGHV-Status und der Patientenfitness. Aktuelle klinische Daten unterstreichen die gute Wirksamkeit der neuen Substanzen sowohl in der Rezidiv- als auch in der Erstlinientherapie. Erworbene Bruton-Tyrosinkinase(BTK)-Resistenzen, medikamentenspezifische Nebenwirkungen und mangelnde Patienten-Compliance sind klinisch ein zunehmendes Problem der neuen Substanzen. Zudem gibt es nur wenige Daten zu Langzeittoxizitäten. Patienten sollten deswegen, wenn immer es geht, innerhalb klinischer Studien behandelt werden. In diesem Übersichtsartikel sollen auf die neuesten Entwicklungen der Diagnostik und Therapie der chronischen lymphatischen Leukämie (CLL) eingegangen und die wichtigsten Aspekte für die Praxis heraus gearbeitet werden.

Schlüsselwörter

TP53-Status IGHV-Status Neue Substanzen Erstlinientherapie Rezidivtherapie 

Current treatment strategies for chronic lymphocytic leukemia

Abstract

Due to an increasing molecular understanding of the signal pathways of B‑lymphocytes and identification of the kinases involved, many new targeted treatments could be developed. The most and best researched are the kinase inhibitors ibrutinib and idelalisib as well as the BCL2 inhibitor venetoclax. A variety of prognostic and predictive biomarkers have been identified. Currently the selection of first-line treatment is oriented to the TP53 status, immunoglobulin heavy chain gene (IGHV) mutational status and patient fitness. Recent clinical studies underline the effectiveness of the novel substances as first-line treatment and in recurrence situations. Acquired Bruton tyrosine kinase (BTK) resistance, medication-specific side effects and a lack of patient compliance are an increasing clinical problem of the new substances. Additionally, little is known about the long-term toxicity. Therefore, patients should be treated within clinical trials whenever possible. This review article summarizes the most recent developments in the diagnostics and treatment of chronic lymphocytic leukemia (CLL) and the most important aspects for the practice are worked out.

Keywords

TP53 status IGHV status Novel agents First-line treatment Relapsed/refractory treatment 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

P. Langerbeins: Research & travel support by Janssen. Honoraria by Janssen, Abbvie. Advisory Board: Sunesis, Janssen. B. Eichhorst: Research support: Roche, Janssen, Abbvie, Gilead. Advisory Board: Janssen, Gilead, Roche, Abbvie, Novartis, Celgene. Honoraria: Roche, Novartis, Gilead, Janssen, Abbvie, Celgene. M. Hallek: Research support for Roche, Gilead, Mundipharma, Janssen, Celgene, Pharmacyclics, Abbvie. Speakers bureau and Advisory Board: Roche Gilead, Mundipharma, Janssen, Celgene, Pharmacyclics, Boehringer.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • Petra Langerbeins
    • 1
    Email author
  • Barbara Eichhorst
    • 1
  • Michael Hallek
    • 1
  1. 1.Klinik I für Innere Medizin und CIO Köln BonnUniversität KölnKölnDeutschland

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