FIRST-LINE THERAPY OF ADVANCED CHRONIC LYMPHOCYTIC-LEUKEMIA

There is general agreement that patients with advanced chronic lymphoc ytic leukemia (CLL) should be treated if they develop anemia or thromb ocytopenia. The combination of chlorambucil (CLB) and prednisone is of ten used for first-line therapy of these patients, but compared to mon otherapy with CLB, no difference in survival could be demonstrated. St eroids should be generally reserved, therefore, for the management of complications such as hemolytic anemia and thrombocytopenia or other a utoimmune manifestations. CLB can still be considered standard therapy for advanced CLL, since polychemotherapy protocols as well as newer a gents such as fludarabine have failed to show an improvement in surviv al compared to CLB. However, the results regarding response and surviv al of the CLB-treated patients seem to depend on dosage intensity and treatment duration. Biological response modifiers such as interferons, interleukins, and monoclonal antibodies have not improved responses o r remission duration. Because experiences with CLL patients are limite d, the indications and procedure of bone marrow transplantation are no t yet clear. However, since results of current treatment protocols are unsatisfactory, regardless of age, patients should be involved in cli nical studies that address the question whether high-dose CLB, fludara bine or the combination of fludarabine with other active agents can im prove patients' outcome. In addition, autologous and allogeneic bone m arrow transplantation as a consolidation therapy is under study and mi ght be a step towards a potential cure of this disease.