New therapeutic issues in CLL.

The treatment armamentarium for CLL has dramatically increased in the last few years. New cytotoxic agents such as the purine analogues produce a high number of responses which in some cases can be molecular. The synergism between purine analogues and other drugs (e.g., cyclophosphamide, platinum, ara-C) has opened the door to the use of purine analogues in combination chemotherapy regimens. In addition, exciting developments are being made in the field of biotherapy, particularly vaccines and monoclonal antibodies. Whereas the use of vaccines is still in its infancy, monoclonal antibodies (e.g., CAMPATH 1H) have already been proved to be highly effective in CLL treatment with response rates similar to those obtained with purine analogues. Finally, transplants of hemopoietic precursors are increasingly performed in young patients with high-risk CLL. The role of transplants in CLL, however, is still unknown and prospective, controlled studies are required to determine its potential role in the management of patients with CLL.