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Chronic Lymphocytic Leukemia: A New Treatment Era is Born

Conference Correspondent - Conference Highlights ASH

During the 2013 Annual Meeting of the American Society of Hematology, Drs Michael Hallek, John G Gribben, and Tait Shanafelt conducted an educational session titled, “Chronic Lymphocytic Leukemia: A New Treatment Era is Born.” Each physician presented various aspects of managing patients with CLL:

  • In his presentation, “Signaling the End of Chronic Lymphocytic Leukemia? New Frontline Treatment Strategies”, Dr Hallek of the University of Cologne in Cologne, Germany reviewed current diagnostic and therapeutic tools and provided comprehensive recommendations regarding the management of newly diagnosed CLL.1 He emphasized the integration of targeted agents into 1 sequential treatment approach, introducing the “triple-T” concept in CLL management:
    • Tailored: “At the end [of therapy], we would use minimal residual disease (MRD) to determine the length of treatment….We need to limit the duration of the treatment to make these therapies affordable.”
    • Targeted: “We are using targeted agents instead of chemotherapy.”
    • Total: “We would aim to totally eradicate the clone.”

    Dr Hallek predicted that “[Novel signaling] inhibitors will not be used alone…. CLL is caused by different, very complex genetics events. Therefore, we do not have a single target to attack. It is an array of events that take place…. We need to combine agents to embellish their treatment action. Chemotherapy might be needed for initial induction or cytoreduction.”

  • In his presentation, “Immunotherapeutic Strategies Including Transplant: Eradication of Disease”, Dr Gribben of Barts Cancer Institute in London, United Kingdom reported on the state of the art allogeneic stem cell transplantation and immunotherapeutic approaches, including CLL vaccines, CXCR 4 antagonists, adoptive cellular immunotherapies focused on chimeric antigen receptor modified T-cells, CD40 ligand gene therapy, and the immunomodulatory drug, lenalidomide.2 To conclude his presentation, Dr Gribben reminded the audience that “Cancer cells clearly induce changes in the host immune microenvironment…. CLL is a good model in which to study these changes.” In addition to agents targeting CLL cell signaling, he believes that “We can also start to think about targeting other components of the immune microenvironment” to enhance T-cell responses, natural killer cell responses, normal B-cell function, and engender additional microenvironment effects.
  • Dr Shanafelt of Mayo Clinic in Rochester, Minnesota concluded the educational session with his presentation, “Treatment of Older Patients with Chronic Lymphocytic Leukemia: Key Questions and Current Answers”.3 He addressed key issues in the management of elderly patients with CLL, including the importance of classifying patients with CLL in terms of their fitness for treatment, criteria to use when classifying patient fitness, timing of treatment, treatment options, and principles of individualized drug selection. Dr Shanafelt summarized his presentation by stating, “How we select [CLL] therapy is largely influenced by the goals of treatment, which are driven by patient characteristics, not therapy characteristics. Which therapy is best for an individual patient is a strategy-level decision guided by characteristics of the treatment that best achieve the goals.”


  1. Hallek M. Signaling the end of chronic lymphocytic leukemia: new frontline treatment strategies. Hematology Am Soc Hematol Educ Program. 2013;2013:138-150.
  2. Gribben JG, Riches JC. Immunotherapeutic strategies including transplantation: eradication of disease. Hematology Am Soc Hematol Educ Program. 2013;2013:151-157.
  3. Shanafelt T. Treatment of older patients with chronic lymphocytic leukemia: key questions and current answers.  Hematology Am Soc Hematol Educ Program. 2013;2013:158-167.
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Last modified: August 30, 2021