Great progress has been made in our knowledge of the pathophysiology and treatment of CLL in the past two decades. Purine analogs, especially fludarabine, have been shown to be powerful agents against CLL, and the combination of fludarabine, cyclophosphamide, and rituximab has shown a very high rate of complete remission. The direction for future treatments will be to continue to improve the quality of response and to effect disease eradication at the molecular level. The most successful strategy has not yet been defined but will probably involve a combination of cytotoxic chemotherapy and immunotherapy.

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