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Blood, 15 February 2006, Vol. 107, No. 4, pp. 1276-1283. Prepublished online as a Blood First Edition Paper on October 4, 2005; DOI 10.1182/blood-2005-02-0819. This Article Full Text (PDF) All Versions of this Article: 2005-02-0819v1 107/4/1276    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Montserrat, E. Articles by Bosch, F. Search for Related Content PubMed PubMed Citation Articles by Montserrat, E. Articles by Bosch, F. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted March 1, 2005 Accepted September 7, 2005 How we treat refractory chronic lymphocytic leukemia Emili Montserrat*, Carol Moreno, Jordi Esteve, Alvaro Urbano-Ispizua, Eva Gine, and Francesc Bosch Institute of Hematology and Oncology, Department of Hematology, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, Hospital Clinic, Barcelona, Spain * Corresponding author; email: emontse{at}clinic.ub.es. Therapy of patients with CLL has greatly changed over the past few years. After years of stagnation, with treatment revolving around the use of rather ineffective drugs such as alkylators, many patients are now being treated with more effective agents such as purine analogs either alone or combined with other drugs and/or monoclonal antibodies. Treatment of patients refractory to these treatments is particularly challenging and should be decided upon a careful evaluation of the disease, patient's characteristics, and prognostic factors. Refractory disease should be clearly separated from relapsing disease. The only curative therapy for patients with CLL, including those with refractory disease, is allogeneic stem cell transplantation. However, the use of allogeneic transplantation is limited because of the advanced age of most patients and the high transplant-related mortality (TRM). Transplants with non-myeloablative regimens may reduce TRM and to allow to transplant more patients, more safely. For patients in whom an allogeneic transplantation is not feasible or it is deemed inappropriate, participation in phase II trials should be encouraged. Finally, to investigate mechanisms to overcome resistance to therapy in CLL and to identify patients that might gain benefit from early, intensive therapies (e.g., based on biological markers) constitute a challenge that needs active investigation. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: I. D. Giudice, F. R. Mauro, M. S. De Propris, I. D. Starza, D. Armiento, A. P. Iori, G. F. Torelli, A. Guarini, and R. Foa Identification of monoclonal B-cell lymphocytosis among sibling transplant donors for chronic lymphocytic leukemia patients. Blood, September 24, 2009; 114(13): 2848 - 2849. [Full Text] [PDF] M. Buchner, S. Fuchs, G. Prinz, D. Pfeifer, K. Bartholome, M. Burger, N. Chevalier, L. Vallat, J. Timmer, J. G. Gribben, et al. Spleen Tyrosine Kinase Is Overexpressed and Represents a Potential Therapeutic Target in Chronic Lymphocytic Leukemia Cancer Res., July 1, 2009; 69(13): 5424 - 5432. [Abstract] [Full Text] [PDF] D. Rossi, M. Cerri, C. Deambrogi, E. Sozzi, S. Cresta, S. Rasi, L. De Paoli, V. Spina, V. Gattei, D. Capello, et al. The Prognostic Value of TP53 Mutations in Chronic Lymphocytic Leukemia Is Independent of Del17p13: Implications for Overall Survival and Chemorefractoriness Clin. Cancer Res., February 1, 2009; 15(3): 995 - 1004. [Abstract] [Full Text] [PDF] M. Lopez-Guerra, L. Trigueros-Motos, M. Molina-Arcas, N. Villamor, F. J. Casado, E. Montserrat, E. Campo, D. Colomer, and M. Pastor-Anglada Identification of TIGAR in the equilibrative nucleoside transporter 2-mediated response to fludarabine in chronic lymphocytic leukemia cells Haematologica, December 1, 2008; 93(12): 1843 - 1851. [Abstract] [Full Text] [PDF] J. Schetelig, A. van Biezen, R. Brand, D. Caballero, R. Martino, M. Itala, J. A. Garcia-Marco, L. Volin, N. Schmitz, R. Schwerdtfeger, et al. 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