New aspects of the treatment of chronic lymphocytic leukemia.

Progress in the understanding of the biology of chronic lymphocytic leukemia and in the development of new and effective therapies has generated a shift in treatment paradigms within only a few years. Traditional chemotherapy agents such as alkylators or nucleoside analogs are rapidly being replaced by combination regimens. Combinations of monoclonal antibodies with chemotherapy agents (chemoimmunotherapy) have proved especially powerful, almost doubling clinical complete response rates compared with chemotherapy alone. In addition to an increase in the number of responders, eradication of residual disease and achievement of molecular responses have become possible, leading to novel treatment concepts including consolidation and maintenance. New therapeutic agents and vaccines are in development and are being evaluated in clinical trials. Cytogenetic-molecular characterization has begun to be tailored into treatment considerations and it is hoped that the combination of molecular biology with effective therapies will lead to risk-adapted strategies and improved survival.