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Evolution in the management of chronic lymphocytic leukemia in Japan: should MRD negativity be the goal?

  • Progress in Hematology
  • B1cells: their ontogeny and malignant counterpart
  • Published:
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A Correction to this article was published on 27 August 2022

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Abstract

Advances in the molecular biology of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and development of molecularly targeted therapies have resulted in treatment innovations. Therapeutic approaches for previously untreated CLL/SLL patients are changing from chemoimmunotherapy (CIT) to molecularly targeted drugs. The aim of therapy for CLL patients has been to control the disease; however, FCR (fludarabine, cyclophosphamide, rituximab) has improved outcomes and reduced the high incidence of undetectable minimum/measurable residual disease (MRD) in previously untreated CLL patients with no 17p deletion/TP53 disruption and mutated immunoglobulin heavy chain gene (IGHV). Patients achieving undetectable MRD in the bone marrow are expected to be cured. BTK inhibitors and BCL-2 inhibitors are effective for CLL/SLL patients. However, atrial fibrillation and bleeding are associated with the BTK inhibitor, ibrutinib, while tumor lysis syndrome is an adverse event (AE) of the BCL-2 inhibitor, venetoclax. Although these novel targeted drugs are very useful, they are also expensive. Emergence of resistant clones of CLL cells must also be addressed. Therefore, treatments of indefinite duration until progression have been replaced by fixed-duration treatments. This review introduces advances in the treatment of previously untreated CLL/SLL patients in Europe and the United States.

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Acknowledgements

The funding has been received from Kyowa Hakko Kirin with Grant No. Grant, Chugai Pharmaceutical with Grant No. Grant, Astellas Pharma with Grant No. Grant, Eisai with Grant No. Grant, Takeda Pharmaceutical Company with Grant No. Grant, Celgene with Grant No. Grant, Chugai Pharmaceutical with Grant No. Personal Fees, Eisai with Grant No. Personal Fees, Takeda Pharmaceutical Company with Grant No. Personal Fees, Janssen Pharmaceuticals with Grant No. Personal Fees, Bristol-Myers Squibb with Grant No. Personal Fees, AbbVie with Grant No. Personal Fees, AstraZeneca with Grant No. Personal Fees, Shin-Nihon Kagaku with Grant No. Grant, Chugai Pharmaceutical with Grant No. Grant, Chugai Pharmaceutical with Grant No. Personal Fees, Kyowa Hakko Kirin with Grant No. Grant, Kyowa Hakko Kirin with Grant No. Personal Fees, Sanofi with Grant No. Grant, AstraZeneca with Grant No. Grant, AstraZeneca with Grant No. Personal Fees, AbbVie with Grant No. Personal Fees, Ono Pharmaceutical with Grant No. Grant, Ono Pharmaceutical with Grant No. Personal Fees, Eisai with Grant No. Grant, Eisai with Grant No. Personal Fees, Nippon Shinyaku with Grant No. Grant, Nippon Shinyaku with Grant No. Personal Fees, Dainippon Sumitomo Pharma with Grant No. Grant, Dainippon Sumitomo Pharma with Grant No. Personal Fees, Celgene with Grant No. Personal Fees, Mochida Pharmaceutical Company with Grant No. Grant, Mochida Pharmaceutical Company with Grant no. Personal Fees, Daiichi-Sankyo with Grant No. Grant, Daiichi-Sankyo with Grant no. Personal Fees, Takeda Pharmaceutical Company with Grant No. Grant, Takeda Pharmaceutical Company with Grant no. Personal Fees, Janssen Pharmaceuticals with Grant no. Personal Fees, MSD K.K. with Grant No. Grant, MSD K.K. with Grant no. Personal Fees, Astellas Pharma with Grant No. Grant.

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  1. Junji Suzumiya

    Present address: Department of Hematology, Koga community hospital, 2-30-1 Daikakuji, Yaizu, Shizuoka, 425-0088, Japan

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  1. Innovative Cancer Center/Oncology-Hematology, Shimane University Hospital, 89-1 Enya, Izumo, Shimane, 693-8501, Japan

    Junji Suzumiya

  2. Department of Hematology, Endocrinology and Metabolism, Niigata University, Faculty of Medicine, Niigata, Japan

    Jun Takizawa

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  1. Junji Suzumiya
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Suzumiya, J., Takizawa, J. Evolution in the management of chronic lymphocytic leukemia in Japan: should MRD negativity be the goal?. Int J Hematol 111, 642–656 (2020). https://doi.org/10.1007/s12185-020-02867-0

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