Chronic Lymphocytic Leukemia: Will Recent Major Advances Lead to Cure?
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ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
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Educational Objectives
1. To review the incidence and natural history of chronic lymphocytic leukemia (CLL)
2. To understand various prognostic factors that affect life expectancy in CLL
3. To review the impact of newer therapeutic regimens in patients with CLL
4. To understand and differentiate the various medical complications associated with CLL and those which result from its treatment
In 1967, Dameshek1 described chronic lymphocytic leukemia (CLL) as an “accumulation of immunologically incompetent lymphocytes.” Chronic lymphocytic leukemia can best be described as a lymphoproliferative disorder. Characteristics often include lymphocytosis, lymphadenopathy, and splenomegaly. Most cases of CLL (95%) are B-cell neoplasms; the remaining cases are T-cell neoplasms.2 The stage of B-cell disease is predictive of survival, with median survival ranging from over 10 years to less than 19 months,2 and 9 years for the entire CLL patient population. Major advances have been made in the treatment of CLL over the last 20 years, precipitated by the development of purine analogs, monoclonal antibodies, and bone marrow transplantation. Expectations for treatment are gradually shifting from palliative goals to curative intent. A better understanding of the biology of the disease and treatment complications has improved supportive care for these patients as well.
INCIDENCE AND EPIDEMIOLOGY
B-cell CLL is the most frequently occurring leukemia in adults, comprising 30% of adult leukemias. The incidence in the Western Hemisphere is 3/100,000 individuals. It is very rare in Japan. For the geriatric population, the incidence in adults over the age of 70 is almost 50/100,000.3 Median age at diagnosis is 65 years.
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