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CLL is a B cell malignancy that is usually incurable. However, the disease often progresses slowly and treatment can keep it under control for many years. Many patients achieve a state of treatment induced remission, the disease is inactive, no symptoms are apparent and blood tests are negative. If the disease becomes active again, more chemotherapy can be given with the aim of achieving a second remission.
For all stages of CLL, an average of 44% of men and 52% of women live for at least 5 years after diagnosis. However, an individual's outlook is largely dependant on the stage of disease present at the time of diagnosis. CLL has 3 stages - A, B and C. Taking recent UK statistics: patients diagnosed at the earliest stage (A), generally live for 10 years or more. Patients diagnosed at the intermediate stage (B), generally live for 5-8 years. Patients diagnosed at the most advanced stage (C), usually live for 1-3 years. However, these figures cannot directly predict an individual's life expectancy with chronic lymphocytic leukemia, as no two patients are exactly alike.
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Current Treatment of CLL
In patients diagnosed in the earliest stages, the disease may be asymptomatic, requiring no therapy, but in patients diagnosed at advanced stages or with symptomatic disease, treatment is necessary.
Prognostic markers can help predict which patients are likely to have progressive disease and therefore need more frequent monitoring. Some of these prognostic factors can also determine therapy choices as they can predict response to treatment.
Traditional chemotherapy of CLL utilises alkylating agents or purine analogs. These are often given together in combination with monoclonal antibodies targeting CD20. Chemoimmunotherapy with fludarabine, cyclophosphamide and rituximab have proved to be the most effective therapy to date. Bendamustine has recently been approved by the FDA for CLL treatment since initial trials using bendamustine and rituximab in combination have shown promising results.
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Future Perspectives on CLL Treatment
Treatment of CLL has changed greatly in recent years and outcomes have improved. A recently published Swedish study found life expectancy with chronic lymphocytic leukemia has improved in the last decade. Improved 5 and 10 year relative survival was found for all age groups and in both men and women. Compared to females however, males had a significantly inferior survival in all age groups. Younger CLL patients had better survival rates than older patients.
The observed improvements in survival are likely due to improved therapies and supportive care. However future research is needed to better understand the differences in survival between patients of different ages and sex.
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Improved survival in chronic lymphocytic leukemia in the past decade: a population-based study including 11,179 patients diagnosed between 1973–2003 in Sweden, by S.Kristinsson, P.Dickman, W.Wilson, N.Caporaso, M.Björkholm and O.Landgren. Haematologica. 2009 Vol 94, P1259–1265
Chronic lymphocytic leukemia: putting new treatment options into perspective. J.Pinilla-Ibarz & A.McQuary. Cancer Control. 2010, Vol 17, P 4-15.
Cancer Research UK Website: www.cancerhelp.uk