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Authors' disclosures of potential conflicts of interest are found at the end of this article. C hronic lymphocytic leu-kemia (CLL) is a ma-lignancy arising from a monoclonal population of mature B cells (Chiorazzi, Rai, & Ferrarini, 2005). Chronic lympho-cytic leukemia is typically considered a disease of the elderly with a median age at diagnosis of approximately 70 years and is the most common adult leukemia in Westernized countries (Smolewski, Witkowska, & Korycka-Wolowiec, 2013). When these cells are predominantly found in the lymph nodes as compared to the bone marrow, the disease is referred to as small lymphocytic lymphoma (SLL; National Comprehensive Cancer Network [NCCN], 2014). As these disorders share some common characteristics with other B-cell neoplasms, they are frequently grouped in the classification known as indolent non-Hodgkin lymphoma (NHL). While the natural progression of CLL varies according to the genetic and pathophysiologic characteristics of the cancer cells, treatment has traditionally depended more on patient factors than tumor factors. Chemo-therapy regimens including both al-kylating agents and purine analogs have shown significant efficacy against this disease, despite their inherent toxicities (NCCN, 2014). Since no benefit has been derived from treating early nonsymptomatic disease, treatment is typically deferred until clinical symptoms present. Standard therapy for younger patients without significant comorbidities includes more aggressive regimens like fludarabine, cyclophosphamide, and rituximab, also known as FCR, while elderly patients or those with significant comorbidities receive more easily tolerated regimens like bendamustine and rituximab, also known as BR, or rituximab monotherapy (NCCN, 2014; Byrd et al., 2014). Although significant gains have been realized through the incorporation of newer less toxic, targeted therapies, there still remains a subset of patients with limited treatment options. These patients include those

Idelalisib: The First-in-Class Phosphatidylinositol 3-Kinase Inhibitor for Relapsed CLL, SLL, and Indolent NHL