Strategies to Improve Treatment - Recurrent Chronic Lymphocytic Leukemia

This content has been reviewed and approved by

Hagop M. Kantarjian, MD
Chairman & Professor, Leukemia Department
MD Anderson Cancer Center
University of Texas

The progress that has been made in the treatment of recurrent chronic lymphocytic leukemia (CLL) has resulted from the incorporation of new anticancer agents and monoclonal antibodies into treatment regimens and the performance of clinical trials. Future progress will result from continued participation in appropriate clinical trials. Currently, there are several areas of active exploration aimed at improving the treatment of CLL.

New chemotherapy regimens - Development of multidrug chemotherapy regimens that incorporate new or additional anticancer therapies is an active area of clinical research. Fludara^® (fludarabine phosphate), Leustatin^® (cladribine), and Nipent^® (pentostatin) are all anticancer agents being evaluated in combination. Other agents include Revlimid^® (lenalidomide) and bendamustine.

Recurrent T-cell CLL - Most lymphoid cancers involve B-lymphocytes, which are the antibody-producing cells in the body. T-lymphocytes are responsible for cellular immunity and fight infections directly rather than through antibodies. Cancers of T-lymphocytes include CLL, Sézary syndrome, mycosis fungoides, and T-zone lymphoma. These patients are usually treated with cyclophosphamide, Leukeran^® (chlorambucil), or combination chemotherapy.

In general, patients with T-cell cancer have worse outcomes than patients with B-cell cancers of the lymphoid system. New regimens have included combinations of pentostatin and alemtuzumab, and new drugs—such as nelarabine and forodesine—and histone deacetylase inhibitors, such as suberoylanilide hydroxamic acid (SAHA).

Monoclonal antibodies - Other than Rituxan^® (rituximab) and Campath^® (alemtuzumab), many new monoclonal antibodies that target CLL signals have been developed and are currently undergoing testing.

Gene therapy - Gene therapy is defined as the transfer of new genetic material into a cell for therapeutic benefit. This can be accomplished by replacing or inactivating a faulty gene or replacing or adding a functional gene into a cell to make it function normally. Gene therapy has been directed towards the control of rapid growth of cancer cells, control of cancer death, or efforts to make the immune system kill cancer cells.