编者按：慢性淋巴细胞白血病（CLL）是以B淋巴细胞为主的淋巴细胞增殖性疾病，临床预后具有显著的异质性。随着细胞生物学、细胞免疫学及分子遗传学的进展，CLL预后指标除了年龄、疾病分期（Rai/Biet分期）、外周血淋巴细胞计数、免疫表型等，还增加了细胞遗传学异常及其他血清学标志物，此外也涌现出一系列新型药物用于CLL的治疗。在刚结束的美国血液学会（ASH）年会上，组委会特别设计了“How I Treat: Bringing Science to Clinical Dilemmas”这一环节，针对CLL在基础与临床的研究进展进行了探讨。会后，《肿瘤瞭望》记者专访了主讲嘉宾、美国国立卫生研究院贝塞斯达国家心肺与血液研究所Adrian Wiestner教授。
《肿瘤瞭望》：在许多新型制剂可供选择的情况下，骨髓移植在治疗CLL的作用？
Prof. Wiestner: That is a question that is really being revisited at this point. There is a new guideline paper out on this topic. What is becoming clear is that ibrutinib works very well for relapsed refractory patients and maybe also for very long periods of time， so transplant becomes less important overall. On the other hand， there are patients who breakthrough on ibrutinib within the first year or two and if we can identify who they are， then treatment with ibrutinib would be a very nice way of preparing patients for transplant. So we could end up with both situations - less transplants in patients who do well but a great bridge to transplant for those who need it.
Wiestner 教授：这确实是一个需要关注的问题，并且对此已经颁布一项新的指南。对于复发或难治性CLL患者，ibrutinib有显著疗效，并且可维持较长时间，因此骨髓移植总体说来并不是非常重要。另一方面，对于那些接受过ibrutinib治疗，并且未能取得理想疗效的患者，ibrutinib治疗作为骨髓移植前重要的桥梁，也不失为一种有效的治疗方案。
肿瘤瞭望：本届ASH年会上有哪些最具突破性的CLL治疗新药？
Prof. Wiestner: The three key areas are kinase inhibitors， the Bcl-2 targeting agents (ABT-199) and immune modulation (either with chimeric T-cells or checkpoint inhibitors， like the anti-PD-1/PD-L1 antibodies). We have three totally different classes of new agents. ASH is the focus point of the year. This meeting has managed to do what many of us strive for in trying to combine clinic， research， laboratory and patients. This is a great mix for everybody. Science and clinical practice go hand-in-hand at this meeting and I think that is why it is a very successful meeting.
Wiestner 教授：CLL治疗新药物的研发主要包括三个重要领域：激酶抑制剂、Bcl-2靶向药物（ABT-199）和免疫调节抑制剂（如anti-PD-1/PD-L1抗体），这是类完全不同类型的新型试剂，并且都有可能成为治疗慢性淋巴细胞白血病的突破性制剂。ASH年会是血液学领域的年度焦点，它将临床、研究、实验及患者紧密连接，对于每位与会者来说都是一次宝贵的学习机会。重视临床实践与科研的紧密结合，我认为是这次会议成功的重要因素。
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