An update on immunotherapies including chimeric antigen receptor T-cells therapy and stem cell transplantation in chronic lymphocytic leukemia

Immunotherapy has become a cornerstone of therapy in oncology. For chronic lymphocytic leukemia (CLL), the treatment landscape has been changing quickly. What historically has been a disease treated with chemoimmunotherapy, and transplant in select cases, now has several newly available, targeted therapies. Many of the newly approved therapies are targeted at the B cell receptor pathway, and also have notable effect on the tumor microenvironment. Additionally, there are a number of trials looking at immune checkpoint blockade in CLL with promise noted when combined with other immune modulating therapies. Many advances have also been made in cellular therapies in CLL, including methods of allogeneic stem cells transplantation and bioengineered chimeric antigen receptor T-cells (CAR-T) which direct the immune system to kill cancer cells expressing specific antigens. The latter therapy may ultimately allow patients to avoid the risks of an allogeneic transplant while harnessing a T cell vs. leukemia effect. The future of therapy in CLL may include utilization of novel immunotherapies in combination with agents that target key pathways such a B cell receptor signaling and cell death machinery.