Chronic lymphocytic leukemia.
Chronic lymphocytic leukemia.
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DOI：
10.1182/asheducation-2002.1.193
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发表时间：
2002-01-01
期刊：
影响因子：
--
通讯作者：
Lin, Thomas
中科院分区：
文献类型：
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作者：
Kay, Neil E;Hamblin, Terry J;Lin, Thomas
早期B细胞慢性淋巴细胞白血病（B-CLL）的这一更新包含了诊断，生物学和干预所需的更充分地开发这种疾病的管理算法的当前信息。强调早期是基于我们对疾病参数的理解的快速进步，以及我们预测给定早期患者是否需要更积极的管理的能力的提高。在第一节中，Terry Hamblin博士讨论了疾病的性质、准确的诊断程序、早期“临床前”阶段的证据、使用更新的预后特征来区分谁可能进展或不进展，以及是否最好观察或治疗早期疾病。在第二部分，Neil Kay博士及其同事讨论了该疾病的生物学方面以及它们如何与疾病进展相关。对基因表达、复发性遗传缺陷、细胞因子/自分泌途径的作用以及CLL B细胞与微环境的相互作用的新见解进行了回顾。还考虑了这些事件与触发疾病进展和作为未来治疗干预机会（即使在早期疾病中）的关系。在第三节中，John Byrd博士和他的同事回顾了以前未经治疗的进展性B-CLL患者的历史和目前的管理方法。他们讨论了在治疗给定患者的初始决策中可以使用什么决策树。使用单一药物与较新的组合方法，如化学免疫治疗进行了讨论。此外，骨髓移植的地方和一些较新的抗体可用于治疗B-CLL的考虑。最后，一个挑战，利用我们不断增长的知识的生物学B-CLL的早期阶段B-CLL。
This update of early stage B-cell chronic lymphocytic leukemia (B-CLL) embraces current information on the diagnosis, biology, and intervention required to more fully develop algorithms for management of this disease. Emphasis on early stage is based on the rapid advancement in our understanding of the disease parameters and our increasing ability to predict for a given early stage patient whether there is a need for more aggressive management. In Section I, Dr. Terry Hamblin addresses the nature of the disease, accurate diagnostic procedures, evidence for an early "preclinical" phase, the use of newer prognostic features to distinguish who will be likely to progress or not, and whether it is best to watch or treat early stage disease. In Section II, Dr. Neil Kay and colleagues address the biologic aspects of the disease and how they may relate to disease progression. Review of the newer insights into gene expression, recurring genetic defects, role of cytokines/autocrine pathways, and the interaction of the CLL B cell with the microenvironment are emphasized. The relationship of these events to both trigger disease progression and as opportunities for future therapeutic intervention even in early stage disease is also considered. In Section III, Dr. John Byrd and colleagues review the historical and now current approaches to management of the previously untreated progressive B-CLL patient. They discuss what decision tree could be used in the initial decision to treat a given patient. The use of single agents versus newer combination approaches such as chemoimmunotherapy are discussed here. In addition, the place of marrow transplant and some of the newer antibodies available for treatment of B-CLL are considered. Finally, a challenge to utilize our growing knowledge of the biology of B-CLL in the early stage B-CLL is proffered.