RESUMO
Antecedentes y objetivo: El amplio arsenal terapéutico junto con la heterogeneidad biológica de los pacientes hace que sea difícil estandarizar el tratamiento de la leucemia linfocítica crónica (LLC) en la práctica clínica. Estas consideraciones han motivado la preparación del presente documento de consenso, que se trata de una actualización de la versión publicada en 2013, prestando especial atención a las estrategias de tratamiento que han aparecido en los últimos 5 años, como los inhibidores del receptor de células B (ibrutinib e idelalisib), los nuevos anticuerpos monoclonales anti-CD20 (ofatumumab y obinutuzumab) y los inhibidores de Bcl-2 (venetoclax). Material y métodos: Un grupo de expertos del Grupo Español de Leucemia Linfocítica Crónica ha revisado la bibliografía publicada entre 2010 y 2016 para poder establecer una serie de recomendaciones basadas en la evidencia clínica. En aquellas áreas donde no se encontró una evidencia científica, el grupo de expertos estableció recomendaciones por consenso con base en sus experiencias clínicas. Resultados: Como resultado del proyecto se ha establecido un conjunto de recomendaciones de carácter práctico que facilitarán el diagnóstico, el tratamiento y el seguimiento de los pacientes con LLC. Conclusiones: Existen muchos aspectos del tratamiento de la LLC que resultan ser temas controvertidos sobre los que no hay estudios apropiados para generar recomendaciones de forma consensuada (AU)
Background and objective: The broad therapeutic arsenal and the biological heterogeneity of patients with chronic lymphocytic leukemia (CLL) makes it difficult to standardize treatment for CLL patients with specific clinical settings in routine clinical practice. These considerations prompted us to elaborate the present consensus document, which constitutes an update of the previous version published in 2013, mainly focusing on novel treatment strategies that have been developed over last 5 years, namely B-cell receptor inhibitors (ibrutinib and idelalisib), anti-CD20 monoclonal antibodies (ofatumumab and obinutuzumab), and Bcl-2 inhibitors (venetoclax). Material and methods: A group of experts from the Spanish Chronic Lymphocytic Leukemia Group reviewed all published literature from January 2010 to January 2016, in order to provide recommendations based on clinical evidence. For those areas without strong scientific evidence, the panel of experts established consensus criteria based on their clinical experience. Results: The project has resulted in several practical recommendations that will facilitate the diagnosis, treatment, and follow-up of patients with CLL. Conclusions: There are many controversial issues in the management of CLL with no appropriate studies for making consensus recommendations (AU)
Assuntos
Humanos , Masculino , Feminino , Leucemia Linfocítica Crônica de Células B/diagnóstico , Leucemia Linfocítica Crônica de Células B/terapia , Anticorpos Monoclonais/uso terapêutico , Proteínas Proto-Oncogênicas c-bcl-2/uso terapêutico , Antígenos CD20/análise , Medicina Baseada em Evidências/métodos , Consenso , Prognóstico , Qualidade de Vida , Grupos de RiscoRESUMO
BACKGROUND AND OBJECTIVE: The broad therapeutic arsenal and the biological heterogeneity of patients with chronic lymphocytic leukemia (CLL) makes it difficult to standardize treatment for CLL patients with specific clinical settings in routine clinical practice. These considerations prompted us to elaborate the present consensus document, which constitutes an update of the previous version published in 2013, mainly focusing on novel treatment strategies that have been developed over last 5 years, namely B-cell receptor inhibitors (ibrutinib and idelalisib), anti-CD20 monoclonal antibodies (ofatumumab and obinutuzumab), and Bcl-2 inhibitors (venetoclax). MATERIAL AND METHODS: A group of experts from the Spanish Chronic Lymphocytic Leukemia Group reviewed all published literature from January 2010 to January 2016, in order to provide recommendations based on clinical evidence. For those areas without strong scientific evidence, the panel of experts established consensus criteria based on their clinical experience. RESULTS: The project has resulted in several practical recommendations that will facilitate the diagnosis, treatment, and follow-up of patients with CLL. CONCLUSIONS: There are many controversial issues in the management of CLL with no appropriate studies for making consensus recommendations.
