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Vol. 18, Art. 25 (pp. 362-381)    |    2017       

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The efficacy of modern drugs in achieving the Mrd-negative status in patients with chronic lymphocytic leukemia

Kuvshinov A.Y., Voloshin S.V., Martynkevich I.S., Mikhaleva M.A., Bessmeltsev S.S., Chechetkin A.V.

The Federal State Budgetary Institution "Russian Research Institute of Hematology and Transfusiology of the Federal Medical and Biological Agency"

Brief summary

Long-term control of such a disease as chronic lymphocytic leukemia (CLL) in the era of chemoimmunotherapy strongly correlates with the quality and depth of remission. Nevertheless, in a significant number of patients, even with complete remission (CR) of the disease, a certain number of tumor cells are retained, which can only be determined by highly sensitive methods (immunological, molecular genetic). The detection of more than one tumor cell per 10000 normal is the essence of the term "minimal residual disease" (MRD). It is proved that the achievement of MRD-negative status directly correlates with long-term progression-free survival (PFS) and overall survival (OS). In addition, MRD is the only prognostic factor determined after therapy. Over the past 5 years, the management of patients with CLL and the standard of therapy have undergone significant changes. The emergence of targeted drugs for CLL therapy (ibrutinib, idelalisib, venetoclax) allowed successfully treating patients from the unfavorable prognosis group (del(17p), the unmutated immunoglobulin variable heavy-chain gene status), and also expanded the possibilities of therapy of progression/relapse of the disease. In addition to high efficiency, these drugs demonstrated a low toxicity profile, which is an important factor in the treatment of elderly and previously treated patients. All this allows us to hope for an increase in the effectiveness of treatment (including increasing the number of MRD-negative remissions) and maintaining a long-term remission by controlling the residual tumor clone.


Key words

chronic lymphocytic leukemia, minimal residual disease, ibrutinib, venetoclax, obinutuzumab.

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