2014 YEAR IN REVIEW

It has been a very good year for chronic lymphocytic leukemia (CLL).  As a community of CLL physicians and patients, we should be grateful that the development of new treatments has led to very gratifying improvements in outcome and quality of life of patients with CLL.  The approval of new agents so that they are more widely available outside of clinical trials, is slow, torturous, and expensive.  2014 led to the approval of two new agents,ibrutinib (Imbruvica) and idelalisib (Zydelig) based on comparative clinical trials demonstrating improvement in not only response rate but progression-free survival and overall survival.  While no drugs are free of side effects, these agents by and large are very well tolerated and can be specifically directed to the care of patients that have other medical conditions.  As they are oral, they are very well tolerated and don't intrude on the patient's lifestyle in the same way that agents that need to be given by intravenous infusions do. 

In addition, ofatumumab, a monoclonal antibody against CD20, a major target of lymphomas and CLL, received expanded approval based on evidence of improved progression-free survival in patients with CLL when combined with chlorambucil. Ofatumumab (Arzerra), when combined with chlorambucil, has been demonstrated to be superior to chlorambucil and the standard monoclonal antibody, rituximab.  The range of options that are available to clinicians and patients is expanding significantly.  There is also very good news in early clinical trials that a new agent, ABT199, will also be very effective in CLL.  Thus while the traditional approved therapies with chemotherapy with or without monoclonal antibodies have been a very significant improvement with the potential of a number of patients being cured of their CLL, these regimens were not as well tolerated by older patients and those with other illnesses.

The lessons that we have learned from these agents that were greatly expanded in 2014 will be the launching platform for the new approaches that will expand the ability of the patient's own immune system to assist in the killing of remaining CLL cells.  As we are nearing 2015 and as a clinical research physician I can't wait to get to 2015 as the possibility of developing extremely promising combinations of approaches is present before us.  None of this could have happened without the willingness of patients to trust the medical community in offering them clinical trials which can not only potentially prolong life and improve the quality of life but potentially cure CLL in a large proportion of patients.  

SEASON OF REFLECTION AND ANTICIPATION

The holiday season is a time to enjoy the companionship of friends and family and to remember loved ones who are no longer with us in person but who remain with us in spirit and in our hearts. It is a time to reflect on our achievements during the previous year and to look forward to the new year with hope and the excitement of new opportunities and experiences.   

In this spirit, please remember CLL Global as you create your holiday gift lists. When loved ones ask what to give you this holiday season, suggest a donation to CLL Global in your honor. Dr. Keating is requesting donations be made in his honor from his friends and family. Feel free to direct your friends and family to www.cllglobal.org or to email us at info@cllglobal.org.