B-CLL is the most common adult leukemia in the Western world. It is a
neoplasia of mature looking B-monoclonal lymphocytes co-expressing the
CD5 antigen (involving the blood, the bone marrow, the lymph nodes and
related organs). Much new information about the nature of the neoplastic
cells, including chromosomal and molecular changes as well as mechanisms
participating in the survival of the leukemic clone have been published
recently, in an attempt to elucidate the biology of the disease and
identify prognostic subgroups. For the time being, clinical stage based
on Rai and Binet staging systems remains the strongest predictor of
prognosis and patients’ survival, and therefore it affects treatment
decisions. In the early stages treatment may be delayed until
progression. When treatment is necessary according to well-established
criteria, there are nowadays many different options. Chlorambucil has
been the standard regimen for many years. During the last decade novel
modalities have been tried with the emphasis on fludarabine and
2-chlorodeoxyadenosine and their combinations with other drugs. Such an
approach offers greater probability of a durable complete remission but
no effect on overall survival has been clearly proven so far. Other
modalities, included in the therapeutic armamentarium, are monoclonal
antibodies, stem cell transplantation (autologous or allogeneic) and new
experimental drugs. Supportive care is an important part of patient
management and it involves restoring hypogammaglobulinemia and
disease-related anemia by polyvalent immunoglobulin administration and
erythropoietin respectively. Copyright (C) 2002 John Wiley Sons, Ltd
