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Blood, 15 February 2006, Vol. 107, No. 4, pp. 1276-1283. Prepublished online as a Blood First Edition Paper on October 4, 2005; DOI 10.1182/blood-2005-02-0819. This Article Full Text Full Text (PDF) All Versions of this Article: 2005-02-0819v1 107/4/1276    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Montserrat, E. Articles by Bosch, F. Search for Related Content PubMed PubMed Citation Articles by Montserrat, E. Articles by Bosch, F. Related Collections Neoplasia How I Treat Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  HOW I TREAT How I treat refractory CLL Emili Montserrat, Carol Moreno, Jordi Esteve, Alvaro Urbano-Ispizua, Eva Giné, and Francesc Bosch From the Institute of Hematology and Oncology, Department of Hematology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain. Therapy for patients with chronic lymphocytic leukemia (CLL) has greatly changed over the past few years. After years of stagnation, with treatment revolving around the use of rather ineffective drugs such as alkylators, many patients are now being treated with more effective agents such as purine analogs either alone or combined with other drugs and/or monoclonal antibodies. Treatment of patients refractory to these treatments is particularly challenging and should be decided only upon a careful evaluation of the disease, patient characteristics, and prognostic factors. Refractory disease should be clearly separated from relapsing disease. The only curative therapy for patients with CLL, including those with refractory disease, is allogeneic stem cell transplantation. However, the use of allogeneic transplantation is limited because of the advanced age of most patients and the high transplant-related mortality (TRM). Transplants with nonmyeloablative regimens may reduce TRM and allow more patients to receive transplants more safely. For patients in whom an allogeneic transplantation is not feasible or in whom it is deemed inappropriate, participation in phase 2 trials should be encouraged. Finally, to investigate mechanisms to overcome resistance to therapy in CLL and to identify patients that might gain benefit from early, intensive therapies (eg, based on biologic markers) constitute a challenge that needs active investigation. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: H. C. Kluin-Nelemans, J. L. Coenen, J. E. Boers, G. W. van Imhoff, and S. Rosati EBV-positive immunodeficiency lymphoma after alemtuzumab-CHOP therapy for peripheral T-cell lymphoma Blood, August 15, 2008; 112(4): 1039 - 1041. [Abstract] [Full Text] [PDF] J.-J. Lee, K. A. Foon, R. B. Mailliard, R. Muthuswamy, and P. Kalinski Type 1-polarized dendritic cells loaded with autologous tumor are a potent immunogen against chronic lymphocytic leukemia J. Leukoc. Biol., July 1, 2008; 84(1): 319 - 325. [Abstract] [Full Text] [PDF] E. Gine, M. Crespo, A. Muntanola, E. Calpe, M. J. Baptista, N. Villamor, E. Montserrat, and F. Bosch Induction of histone H1.2 cytosolic release in chronic lymphocytic leukemia cells after genotoxic and non-genotoxic treatment Haematologica, January 1, 2008; 93(1): 75 - 82. [Abstract] [Full Text] [PDF]

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