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REVIEW ARTICLE
Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 58-62

CLL management in 2022: Indian settings


Department of Hematology and Bone Marrow Transplant, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India

Correspondence Address:
Dr. Narendra Agarwal
Department of Hematology and Bone Marrow Transplant, Rajiv Gandhi Cancer Institute and Research Centre, Sector 5, Rohini, Delhi 110085
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jco.jco_8_22

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Chronic lymphocytic leukemia (CLL) is being increasingly recognised in our adult population. Though typically a disease of elderly, many young patients are also being diagnosed especially in Indian subcontinent. It shows a heterogenous clinical course. The diagnosis is established by complete blood counts, blood smears morphology, and immunophenotyping. The diagnosis is made with identification of clonal B-cell population. The clinical staging systems includes results of physical examination and peripheral blood counts. In addition, there are various biological and genetic markers for further prognostic information. The clinical staging and genetic findings guide us for assessing the need to treat and for selection of therapies. The CLL international prognostic index combines the genetic, biological, and clinical variables for risk stratification of patients with CLL. Only selected patients warrant therapy at the time of diagnosis. In the current settings with availability of newer targeted therapies and chemotherapy, clinicians and patients can together choose amongst the available therapeutic regimens. The targeted therapy includes the Bruton kinase inhibitors including Ibrutinib, acalabrutinib and Bcl2 directed therapy with Venetoclax. These therapies can be used as single agent therapy or in combination. Though in west, therapy has majorly shifted to targeted therapy from chemotherapy, we in India are still in the transition phase. Future challenges: Potentially curative treatment regimen of finite duration is being investigated. More studies are needed for improving the outcomes of poor risk group with del17p, Tp53 deletion and in refractory cases. The optimal sequencing of targeted therapies also needs to be determined.


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