Sandbox:therapy

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  • Asymptomatic chronic lymphocytic leukemia patients are managed with observation, whereas symptomatic chronic lymphocytic leukemia patients are treated with immunochemotherapy.
  • Indications to initiate immunochemotherapy among patients with chronic lymphocytic leukemia include:
  • Symptomatic chronic lymphocytic leukemia patients presenting with:
  • Fever of unknown origin (>38.1°C for a period greater than two weeks)
  • Night sweats for more than one month
  • Unintentional significant weight loss over a period of six months
  • Patients presenting with thrombocytopenia or anemia due to bone marrow failure
  • Patients presenting with refractory autoimmune anemia or refractory autoimmune thrombocytopenia
  • Evidence of symptomatic splenomegaly, with the spleen being palpated more than 6cm below the costal margin
  • Evidence of symptomatic progressive lymph nodes swelling, with a size greater than 10 cm in diameter
  • Evidence of a rapidly progressive lymphocytosis, which may be indicated by:
  • An increase of greater than 50% over a 2-month period
  • A lymphocyte doubling period shorter than six months
  • The optimal therapy for chronic lymphocytic leukemia depends on a number of factors which include:
  • The clinical presentation of the patients
  • The stage of the tumor
  • The presence of specific genetic mutations
  • The performance status of the patients
  • First line therapy vs. second line therapy
  • The mainstay of therapy for symptomatic chronic lymphocytic leukemia patients is combination immunochemotherapy.
  • Immunochemotherapies for chronic lymphocytic leukemia include purine analogues, alkylating agents, monoclonal antibodies, Tyrosine kinase and B-Cell receptor pathway inhibitors.
  • Purine analogues used for the management of chronic lymphocytic leukemia patines may include:
  • Cladribine
  • Fludarabine
  • Pentostatin
  • Alkylating agents used for the management of chronic lymphocytic leukemia patients may include:
  • Bendamustine
  • Chlorambucil
  • Cyclophosphamide
  • Monoclonal antibodies used for the management of chronic lymphocytic leukemia patients may include:
  • Rituximab
  • Ofatumumab
  • Obinutuzumab
  • Alemtuzumab
  • Immunomodulatory agents used for the management of chronic lymphocytic leukemia patients may include:
  • Lenalidomide
  • Tyrosine kinase and B-Cell receptor pathway inhibitors used for the management of chronic lymphocytic leukemia patients may include:
  • Idelalisib (targets phosphoinositide 3-kinase delta)
  • Ibrutinib (targets bruton tyrosine kinase)