In the recent years, the armamentarium for the treatment of hematological malignancies has been substantially enriched by the implementation of novel classes of drugs that target specific signaling or metabolic pathways and/or the microenvironment of the malignant cells. Proteasome inhibitors and immunomodulatory drugs have revolutionized the treatment of multiple myeloma patients; and this fascinating development is still ongoing as second generation novel drugs and monoclonal antibodies will soon find their way into the clinics, which are likely to further improve the survival of our patients. Small drugs have been also introduced in the treatment of myeloid malignancies and now, such drugs targeting essential pathways are also available for chronic lymphocytic leukemia, the most common leukemic disease in the western world.
In this issue of MEMO, Lukas Weiss and his colleagues give a clinical update on inhibitors of B-cell receptor kinases in this disease. These new agents have potent activity in heavily pretreated patients as well as in patients whose disease is characterized by the chromosomal aberration del(17), a hallmark of a usually dismal prognosis. Despite substantial improvements in the treatment of B-CLL, especially for younger patients using modern immunochemotherapy regimens, the time is ripe for a revolution in the management of very high-risk patients and patients’ refractory to currently established treatments.