慢性淋巴细胞白血病（CLL）定义为血液中至少有5×109 / L的单克隆B细胞，影响超过20万人，每年与大约4410次死亡有关。 CLL与免疫受损状态和感染的并发症率增加有关。诊断时，CLL患者的中位年龄为70岁，估计95％的患者至少有1个医学共病。诊断时约70％至80％的CLL患者无症状，其中三分之一永远不需要治疗CLL。已经开发了预后模型来估计首次治疗时间和总生存期，但对于无症状的患者，不考虑疾病风险类别的临床观察是标准治疗。具有厚重或进展性淋巴结肿大或肝脾肿大以及低中性粒细胞计数，贫血或血小板减少和/或发热，浸泡性夜间出汗和体重减轻（B症状）的对称性疾病患者应提供治疗。对于这些患者，一线治疗包括含有共价布鲁顿酪氨酸激酶（BTK）抑制剂（acalabrutinib，zanubrutinib或ibrutinib）或B细胞白血病/淋巴瘤2（BCL2）抑制剂（venetoclax）的方案。没有证据表明开始任何一类治疗都会改善结果。共价BTK抑制剂通常无限期使用。在4年内，acalabrutinib的生存率约为88％，zanubrutinib的2年生存率为94％，ibrutinib的7年生存率为78％。在一线治疗中，venetoclax与单克隆抗CD20抗体obinutuzumab联合使用1年（总生存率，随访5年82％）。非共价BTK抑制剂pirtobrutinib在共价BTK抑制剂和venetoclax失败后显示出超过70％的总有效率。磷酸肌醇3'-激酶（PI3K）抑制剂（idelalisib和duvelisib）可用于与BTK抑制剂和venetoclax进展的疾病，但患者需要密切监测自身免疫疾病和感染等不良事件。在多次复发的患者中，利索卡布塔静注射式T细胞（CAR-T）疗法的完全缓解率为45％。 CLL的唯一潜在治愈方法是异基因造血干细胞移植，在使用靶向药物后仍是一种选择。在美国，有超过20万人被诊断为CLL，并且CLL每年导致约4410人死亡。约三分之二的患者最终需要治疗。高效的新型靶向药物包括BTK抑制剂，如acalabrutinib，zanubrutinib，ibrutinib和pirtobrutinib，或BCL2抑制剂，如venetoclax。

Chronic lymphocytic leukemia (CLL), defined by a minimum of 5 × 109/L monoclonal B cells in the blood, affects more than 200 000 people and is associated with approximately 4410 deaths in the US annually. CLL is associated with an immunocompromised state and an increased rate of complications from infections.At the time of diagnosis, the median age of patients with CLL is 70 years, and an estimated 95% of patients have at least 1 medical comorbidity. Approximately 70% to 80% of patients with CLL are asymptomatic at the time of diagnosis, and one-third will never require treatment for CLL. Prognostic models have been developed to estimate the time to first treatment and the overall survival, but for patients who are asymptomatic, irrespective of disease risk category, clinical observation is the standard of care. Patients with symptomatic disease who have bulky or progressive lymphadenopathy or hepatosplenomegaly and those with a low neutrophil count, anemia, or thrombocytopenia and/or symptoms of fever, drenching night sweats, and weight loss (B symptoms) should be offered treatment. For these patients, first-line treatment consists of a regimen containing either a covalent Bruton tyrosine kinase (BTK) inhibitor (acalabrutinib, zanubrutinib, or ibrutinib) or a B-cell leukemia/lymphoma 2 (BCL2) inhibitor (venetoclax). There is no evidence that starting either class before the other improves outcomes. The covalent BTK inhibitors are typically used indefinitely. Survival rates are approximately 88% at 4 years for acalabrutinib, 94% at 2 years for zanubrutinib, and 78% at 7 years for ibrutinib. Venetoclax is prescribed in combination with obinutuzumab, a monoclonal anti-CD20 antibody, in first-line treatment for 1 year (overall survival, 82% at 5-year follow-up). A noncovalent BTK inhibitor, pitobrutinib, has shown an overall response rate of more than 70% after failure of covalent BTK inhibitors and venetoclax. Phosphoinositide 3'-kinase (PI3K) inhibitors (idelalisib and duvelisib) can be prescribed for disease that progresses with BTK inhibitors and venetoclax, but patients require close monitoring for adverse events such as autoimmune conditions and infections. In patients with multiple relapses, chimeric antigen receptor T-cell (CAR-T) therapy with lisocabtagene maraleucel was associated with a 45% complete response rate. The only potential cure for CLL is allogeneic hematopoietic cell transplant, which remains an option after use of targeted agents.More than 200 000 people in the US are living with a CLL diagnosis, and CLL causes approximately 4410 deaths each year in the US. Approximately two-thirds of patients eventually need treatment. Highly effective novel targeted agents include BTK inhibitors such as acalabrutinib, zanubrutinib, ibrutinib, and pirtobrutinib or BCL2 inhibitors such as venetoclax.