First-line therapy of chronic lymphocytic leukemia: when and how to treat

Chronic lymphocytic leukemia (CLL) shows a remarkable clinical heterogeneity: there are some patients with smouldering disease who may not have an altered survival due to CLL, and patients who will certainly have shorter expected survival owing to their progressive disease. In the last decade, impressive progress has been achieved in biological characterization of CLL, allowing better understanding of the pathophysiology of the disease and identification of biological features relevant to prognostic stratification. In the same time period, new therapeutic options, including auto and allotransplantation procedures, monoclonal antibodies (Mab) and new drugs have become available, in addition to alkylating agents and purine analogs.