The management of chronic lymphocytic leukemia (CLL) has undergone dramatic changes over the previous 2 decades with the introduction of multiple new therapies and new combinations. Management of the newly diagnosed asymptomatic patient has not significantly changed outside of the development of a number of prognostic factors and the CLL International Prognostic Index, which is helpful in discussions regarding prognosis and likelihood of requiring treatment. When therapy is required, initial treatment of most patients now includes either the Bruton tyrosine kinase inhibitor ibrutinib or the B-cell lymphoma 2 inhibitor venetoclax in combination with obinutuzumab. Current frontline trials are focused on the optimal sequencing or combination of targeted therapies. In this review, we will discuss the management of previously untreated CLL with an emphasis on the clinical trials that have formed the standard of care, as well as those newer studies that are likely to form the next generation of therapy.

中文翻译：

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初治 CLL：2 期和 3 期临床试验的经验教训

随着多种新疗法和新组合的引入，慢性淋巴细胞白血病 (CLL) 的管理在过去 20 年中发生了巨大变化。除了一些预后因素和 CLL 国际预后指数的发展之外，新诊断的无症状患者的管理没有显着变化，这有助于讨论预后和需要治疗的可能性。当需要治疗时，大多数患者的初始治疗现在包括 Bruton 酪氨酸激酶抑制剂依鲁替尼或 B 细胞淋巴瘤 2 抑制剂 venetoclax 联合 obinutuzumab。当前的一线试验侧重于靶向治疗的最佳排序或组合。在这次审查中，