Monoclonal antibodies in the treatment of chronic lymphocytic leukemia

Chemotherapy of CLL underwent significant development in last two decades when after along era of chlorambucil fludarabine entered in the first line of treatment in combination with cyclophosphamide and later with new agent – monoclonal antibody rituximab. The conservative palliative approach with minimal toxicity in elderly is replaced with an effort to tailor treatment of CLL with eradication of minimal residual disease mainly for young and "fit" patients with ambition to prolong survival. Monoclonal antibodies represent anew category of anticancer drugs that mediate cell death utilizing several mechanisms different from classical chemotherapy. Alemtuzumab, rituximab and ofatumumab are currently widely used monoclonal antibodies in CLL. Rituximab represents now a gold standard for initial treatment of "fit" and also "non-fit" patients and for patients with relapsed CLL. After successful clinical studies another new anti-CD20 antibodies were registered for the first line treatment – obinutuzumab and ofatumumab in combination with chlorambucil in treatment of elderly patients with comorbidities. (author)