{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T18:32:32Z","timestamp":1768415552553,"version":"3.49.0"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"16","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Was ist neu?<\/jats:title><jats:p>\n          Diagnostik\u2002Die Aktualisierung der IWCLL-Kriterien lie\u00df die Kriterien f\u00fcr die Diagnosestellung der CLL unber\u00fchrt: In der Regel gen\u00fcgt weiterhin ein Blutausstrich und eine Immunph\u00e4notypisierung.<\/jats:p><jats:p>\n          Therapieindikation\u2002Auch die Kriterien f\u00fcr die Therapieeinleitung blieben unver\u00e4ndert: Nur Patienten mit symptomatischer, fortgeschrittener Erkrankung sollen behandelt werden. Die Untersuchung auf Vorliegen einer Deletion 17p und\/oder TP53-Mutation als wichtigster ung\u00fcnstiger Prognosefaktor und pr\u00e4diktiver Faktor ist essenziell vor Einleitung jeder neuen Therapie. Die Bedeutung des Mutationsstatus der variablen Region des Immunglobulin-Schwerkettengens (IgHV) hat deutlich zugenommen.<\/jats:p><jats:p>\n          Erstlinientherapie der Patienten mit Hochrisikofaktoren Die Kombination des Bcl2-Antagonisten Venetoclax mit dem Antik\u00f6rper Obinutuzumab wurde k\u00fcrzlich f\u00fcr die Erstlinientherapie der CLL zugelassen. Aufgrund der klaren \u00dcberlegenheit gegen\u00fcber Chlorambucil\/Obinutuzumab bei den unfitten, \u00e4lteren Patienten sollte Venetoclax\/Obinutuzumab von nun an die bevorzugte Behandlungsoption bei dieser Patientengruppe sein. Als Chemotherapie-freie und zeitlich limitierte Behandlung wird Venetoclax\/Obinutuzumab auch bei den\u00a0Hochrisikopatienten mit Deletion 17p\/TP53-Mutation und bei den j\u00fcngeren, fitten Patienten k\u00fcnftig eine wichtige Option neben der Dauertherapie mit Ibrutinib darstellen. Bei Letzteren kann bei Vorliegen eines mutierten IgHV-Status auch eine Chemoimmuntherapie mit Rituximab, kombiniert mit Fliudarabin\/Cyclophosphamid oder Bendamustin, erfolgen.<\/jats:p><jats:p>\n          Rezidiv-Therapie\u2002Auch in der Rezidiv-Situation werden vorzugsweise die zielgerichteten Substanzen eingesetzt unter Ber\u00fccksichtigung der zyto- und molekulargenetischen Risikofaktoren der CLL, der Patientencharakteristiken, der Tiefe und Dauer des Ansprechens sowie Vertr\u00e4glichkeit der vorangegangenen Therapie(n).<\/jats:p>","DOI":"10.1055\/a-1039-8472","type":"journal-article","created":{"date-parts":[[2020,8,13]],"date-time":"2020-08-13T22:31:20Z","timestamp":1597357880000},"page":"1139-1144","source":"Crossref","is-referenced-by-count":2,"title":["Aktuelle Standards in der Diagnostik und Therapie der\u00a0chronischen lymphatischen Leuk\u00e4mie"],"prefix":"10.1055","volume":"145","author":[{"given":"Paula","family":"Cramer","sequence":"additional","affiliation":[{"name":"Uniklink K\u00f6ln, Klinik I f\u00fcr Innere Medizin, Deutsche CLL Studiengruppe; Kerpener Str. 62, 50937 K\u00f6ln"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"von Tresckow","sequence":"additional","affiliation":[{"name":"Uniklink K\u00f6ln, Klinik I f\u00fcr Innere Medizin, Deutsche CLL Studiengruppe; Kerpener Str. 62, 50937 K\u00f6ln"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Eichhorst","sequence":"additional","affiliation":[{"name":"Uniklink K\u00f6ln, Klinik I f\u00fcr Innere Medizin, Deutsche CLL Studiengruppe; Kerpener Str. 62, 50937 K\u00f6ln"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Hallek","sequence":"additional","affiliation":[{"name":"Uniklink K\u00f6ln, Klinik I f\u00fcr Innere Medizin, Deutsche CLL Studiengruppe; Kerpener Str. 62, 50937 K\u00f6ln"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2020,8,13]]},"reference":[{"key":"ref2","doi-asserted-by":"crossref","first-page":"2745","DOI":"10.1182\/blood-2017-09-806398","article-title":"iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL","volume":"131","author":"M Hallek","year":"2018","journal-title":"Blood"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1056\/NEJMoa075290","article-title":"Monoclonal B-cell lymphocytosis and chronic lymphocytic leukemia","volume":"359","author":"A C Rawstron","year":"2008","journal-title":"N Engl J Med"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/S1470-2045(16)30029-8","article-title":"An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data","volume":"17","author":"International CLL-IPI working group","year":"2016","journal-title":"Lancet Oncol"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1056\/NEJM199805213382104","article-title":"Chlorambucil in indolent chronic lymphocytic leukemia. 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