Ofatumumab is safe and effective as front-line treatment in older patients with chronic lymphocytic leukemia and severe co-morbidities, including other malignancies

CAR-T treatment for hematological malignancies

Chimeric antigen receptor (CAR)-T-cell therapy has sparked a wave of optimism in hematological malignancies, reflected by the successful results of early clinical trials involving patients with pre-B-cell acute lymphoblastic leukemia, B-cell lymphomas and multiple myeloma. CAR-T-cell therapy is considered to be a novel immunotherapy treatment that has the potential for curing certain hematological cancers. However, as use of CAR-T-cell therapy has grown, new challenges have surfaced. These challenges include the process of manufacturing the CAR-T cells, the mechanisms of resistance that underlie disease relapse, adverse effects and cost. This review describes the published results of clinical trials and expected developments to overcome CAR-T resistance.

Frontline therapies for untreated chronic lymphoid leukemia

Therapy for chronic myeloid leukemia (CLL) is going through a major paradigm shift. Combination chemoimmunotherapy regimens have been the frontline therapies for CLL, whereas chlorambucil remained the standard frontline therapy for older patients (65 years or older) with CLL until recently. Monoclonal antibodies including rituximab, ofatumumab and obinutuzumab have been used for CLL therapy. Novel immunotherapeutics with chimeric antigen receptor (CAR) engineered T cells is rapidly migrating to clinical applications. Targeted therapies with small molecule inhibitors against Bruton tyrosine kinase (BTK) such as ibrutinib and acalabrutinib are playing a major role for treatment of patients with either treatment-naïve or refractory/relapsed CLL. Several major clinical trials including RESONATE-2, iLLUMINATE, ALLIANCE, ECOG 1912, CLL10, CLL14 as well as ibrutinib plus venetoclax have been ongoing in patients with untreated CLL. Frontline therapy of patients with untreated CLL appears to be shifting from chemotherapy to chemotherapy-free regimens. This review summarized latest development for frontline therapies of untreated CLL.