Onkológia 1/2022

Chronic lymphocytic leukemia - how to treat a patient with relapsed or refractory disease in the era of signaling pathway inhibitors

Introduction: treatment options for patients with relapsed / refractory (R / R) chronic lymphocytic leukemia (CLL) were limited and treatment outcomes were unsatisfactory. However, this scenario has changed after the introduction of signaling pathway inhibitors (such as B-cell receptor inhibitors and BCL-2 protein inhibitors). These new molecules have a unique mechanism of action, significant antitumor effect and an acceptable toxicity profile. Case report: in this article we present a case of a young patient with high-risk CLL. We describe the course of the disease, treatment and complications. Conventional chemoimmunotherapy did not provide expected effect in this patient, whereas second-line treatment with Brutone tyrosine kinase (BTK) inhibitor ibrutinib produced a partial response with some toxicity. However, the best and deepest treatment response was achieved with BCL2 inhibitor venetoclax. The patient continues treatment without side effects. Conclusion: in our clinical practice, we have shown that innovative treatment with signaling pathway inhibitors is more effective than conventional chemoimmuotherapy in a patient with CLL with an adverse genetic risk. Our clinical experience confirms the beneficial effect of venetoclax treatment in R / R CLL.

Keywords: chronic lymphocytic leukemia, chemoimmunotherapy, signaling pathway inhibitors, therapeutic response, clinical practice