Modern antitumor therapy of chronic lymphocytic leukemiaand immunological criteria for treatment effectiveness

The review presents literature data on the current problem of treatment and immunological diagnosis of chronic lymphocytic leukemia (CLL). Based on the analysis, it is concluded that the fludarabine, cyclophosphane, and rituximab (FCR) program is highly effective for immediate and long-term evaluation criteria. The effectiveness of this program has been studied not only in randomized clinical trials, but also in real clinical practice based on CLL registries. In essence, the results of FCR therapy for CLL were analyzed in two clinical models that differed in the selection of patients included in the study. However, there were no differences in clinical effect. There was also no high toxicity of this program according to the CLL register. Modern targeted drugs used to treat CLL, such as ibrutinib, venetoclax, idelasib, and monoclonal antibodies against CD20 have been studied in randomized clinical trials. Along with high antitumor activity, they were characterized by high toxicity, accumulation of resistant mutations, and high cost. In this regard, instead of long-term and consistent application, the possibilities of new programs based on other principles are being studied. These include intermittent use of these drugs, combining them to achieve deep remission and a subsequent long break, and combining them with chemoimmunotherapy programs.New approaches to FCR followed by supportive treatment with ibrutinib were characterized by high rates of clinical response and minimal residual disease. An analysis of published scientific studies has shown that the use of the immunophenotypic characteristic of minimal residual disease (0.01 %) is widely used as one of the main criteria for evaluating antitumor treatment in CLL. Information concerning the use of a method for determining free light chains of serum immunoglobulins that are altered in CLL is also interesting. It can be a more informative criterion than immunophenotyping of tumor cells, it is also not related to their adhesiveness and overcomes the topographic asymmetry of the spread of the tumor process in CLL.