Chronic Lymphocytic Leukemia in New Era

Treatment of Chronic Lymphocytic Leukemia (CLL) is entering a new era.Although CLL remains incurable, over the past two decade there have been tremendous advances in understanding the pathophysiology of CLL and in the treatment of this disease.In the last 5 years, several new exciting drugs have entered the realm in hopes for a success in curing the disease.These drugs are falling into different classes such as Bruton tyrosine kinase (BTK) inhibitors, B cell CLL/Lymphoma-2 (BCL-2) inhibitors, CD20 Antibody, phosphatidyl inositol 3-kinase (PI3K) inhibitors, and spleen tyrosine kinase (Syk) inhibitors.Numerous studies have shown that these therapeutic agents have both clinical activity as initial therapy and as treatment of recurrent disease.This has led to greatly treatment goal shifting from symptom palliation to achieve complete remission (CR) and improve survival.Advances in our understanding by using of some prognostic factors that help to identify early high risky patients for progression (including molecular factors) have led us to the question whether there is still a role for a "watch and wait" approach in asymptomatic high-risk patients or whether they should be treated earlier in their disease course.Questions are still remain regarding; what is the optimal first-line of treatment, its timing and what is the beneficial role of maintenance therapy or stem cell transplantation in this disease?The established treatment algorithms for CLL are currently challenged by novel classes of drugs.Targeted drugs are replacing the often-debilitating chemotherapy regimens that have long been the standard of care in CLL.Novel strategies combining or sequencing new agents with established chemotherapy and chemo-immunotherapies combinations are likely to change the treatment of CLL in the near future. Introduction:-Chronic Lymphocytic Leukemia is a monoclonal disorder characterized by a progressive accumulation of functionally incompetent lymphocytes; its onset is usually insidious, and it may be discovered incidentally after a blood cell count is performed for another reason.1 Enlarged lymph nodes are the most common presenting symptom, but patients may present with a wide range of symptoms and signs. 1 It considers the most common disorder of all leukemic forms that can found in adults in Western countries; the American Cancer Society estimates that 18,960 new cases of CLL will be diagnosed in the United States in 2016. 2 Although the incidence of CLL in Western countries is similar to that of the United States; CLL is extremely rare in Asian countries, where it is estimated to comprise only 10% of