A review of supportive care and recommended preventive approaches for patients with chronic lymphocytic leukemia

Management of infections for patient treated with ibrutinib in clinical practice

Ibrutinib, a highly effective inhibitor of the Bruton tyrosine kinase, has significantly transformed the therapeutic approach in chronic lymphocytic leukemia (CLL). Despite these advancements, the disease continues to be characterized by immune dysfunction and increased susceptibility to infections, with mortality rates from infections showing no significant improvement over the past few decades. Therefore, timely prevention, recognition, and treatment of infections remains an important aspect of the standard management of a patient with CLL. A panel of hematologists with expertise in CLL met to discuss existing literature and clinical insights for the management of infectious in CLL undergoing ibrutinib treatment. Despite not being a fully comprehensive review on the topic, this work provides a set of practical recommendations that can serve as a guide to healthcare professionals who manage these patients in their daily clinical practice.

Pregnancy Course of 10 Women Diagnosed with Chronic Lymphocytic Leukemia

Pregnancies following diagnosis of chronic lymphocytic leukemia (CLL) are rare events, mainly because the disease is typically diagnosed in the elderly. Literature on the topic is based only on case reports, and limited data are available on the influence of pregnancy on CLL course. In this retrospective study, we aimed to summarize the clinical and laboratory course of 10 women with CLL who became pregnant. None of the patients had significant changes in blood count during or after pregnancy or had complications such as infection, autoimmune phenomenon, or preeclampsia. Four out of 10 pregnancies were terminated with an early miscarriage. Following labor, 1 patient started anti-CLL treatment due to preexisting anemia, but none of the women required therapy during CLL progression during the first 2 years of follow-up. We conclude that based on our serial, pregnancy does not negatively impact on CLL course.

Infections associated with immunotherapeutic and molecular targeted agents in hematology and oncology. A position paper by the European Conference on Infections in Leukemia (ECIL)

A multitude of new agents for the treatment of hematologic malignancies has been introduced over the past decade. Hematologists, infectious disease specialists, stem cell transplant experts, pulmonologists and radiologists have met within the framework of the European Conference on Infections in Leukemia (ECIL) to provide a critical state-of-the-art on infectious complications associated with immunotherapeutic and molecular targeted agents used in clinical routine. For brentuximab vedotin, blinatumomab, CTLA4- and PD-1/PD-L1-inhibitors as well as for ibrutinib, idelalisib, HDAC inhibitors, mTOR inhibitors, ruxolitinib, and venetoclax, a detailed review of data available until August 2018 has been conducted, and specific recommendations for prophylaxis, diagnostic and differential diagnostic procedures as well as for clinical management have been developed.

In vitro analysis of microRNA-26a in chronic lymphocytic leukemia cells

microRNA (miRNA)‑26a‑loaded liposomes were prepared in the present study for effective treatment of leukemia. The results demonstrated that miRNA‑26a reduced the viability of chronic lymphocytic leukemia (CLL) cells in a concentration‑dependent manner. Cells treated with miRNA‑26a‑loaded liposomes exhibited increased rates of apoptosis, as determined by flow cytometry and Hoechst 33342 staining. Western blot analysis revealed an increased apoptotic effect of miRNA‑26a‑loaded liposomes compared with control. Treatment with these liposomes resulted in significant downregulation of the expression of the miRNA‑26a target genes, myeloid cell leukemia 1 and cyclin‑dependent kinase 6. Taken together, the results of the present study indicate that miRNA‑26a exerts apoptosis‑inducing and anticancer effects on leukemia cells, suggesting therapeutic potential. This approach may be possible to extrapolate to other neoplasms, including lymphomas and acute myeloid leukemia.

Management of unfit elderly patients with chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a disease characterized by an increasing incidence with age reaching 35/100,000 in patients over 85 years. Elderly CLL patients carry several challenges, which have to be considered particularly in advanced stages including a higher risk of infections and individual differences in comorbidities and geriatric syndromes. Although no specific tool for geriatric evaluation in CLL has been developed so far, several of them (e.g. CIRS or Charlson-Score) have been tested in CLL patients. Several treatment options exist for frontline and relapse therapy in unfit CLL patients. Less intensive chemoimmunotherapy with engineered CD20 antibodies (e.g. obinutuzumab) is one of the treatment options, if TP53 mutation or deletion has been ruled out by genetic testing. Single agent treatment with the Btk-inhibitor ibrutinib is not only approved in relapsed CLL; but also for frontline therapy. The kinase inhibitor idelalisib (plus rituximab) and the bcl2 inhibitor venetoclax are other novel compounds, which showed great efficacy in relapsed CLL even in unfit patients. Treatment decisions in unfit patients have to take patient-related as well as disease-related risk factors into consideration.

Synthetic high-density lipoproteins as targeted monotherapy for chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) remains incurable despite the introduction of new drugs. Therapies targeting receptors and pathways active specifically in malignant B cells might provide better treatment options. For instance, in B cell lymphoma, our group has previously shown that scavenger receptor type B-1 (SR-B1), the high-affinity receptor for cholesterol-rich high-density lipoproteins (HDL), is a therapeutic target. As evidence suggests that targeting cholesterol metabolism in CLL cells may have therapeutic benefit, we examined SR-B1 expression in primary CLL cells from patients. Unlike normal B cells that do not express SR-B1, CLL cells express the receptor. As a result, we evaluated cholesterol-poor synthetic HDL nanoparticles (HDL NP), known for targeting SR-B1, as a therapy for CLL. HDL NPs potently and selectively induce apoptotic cell death in primary CLL cells. HDL NPs had no effect on normal peripheral blood mononuclear cells from healthy individuals or patients with CLL. These data implicate SR-B1 as a target in CLL and HDL NPs as targeted monotherapy for CLL.