First-line treatment of chronic lymphocytic leukemia with three combined chemotherapy regimens
Abstract
Background: Chronic lymphocytic leukemia (CLL) is a B-cell lymphoproliferative disease. The diagnosis is based on the clinical evaluation, complete blood count and the evidence of an abnormal population of B lymphocytes on flow cytometry. The indications for treatment are: progressive disease with pancytopenija, enlarged lymph nodes and organs, and B-symptoms. Treatment choices are made upon cytogenetic and molecular evaluation. Methods: The retrospective analysis included 45 patients with CLL, who received first-line treatment with either chlorambucil + methylprednisolone (LP), fludarabine + cyclophosphamide (Flucy) or rituximab + fludarabine + cyclophosphamide (RFC) in the period 2006–2010. We enrolled patients who received at least one cycle of chemotherapy. Kaplan-Meier survival curves and χ2 test for categorical variables were used for statistical analysis. Results: Treatment with RFC resulted in higher rates of complete and partial remissions than treatment with Flucy and LP. Patient receiving LP treatment appear to have lower survival. Deletion 17 in CLL patients is an unfavorable prognostic marker with dismal prognosis. Conclusions: RFC is the first-line treatment of choice for younger fit patients without deletion 17. For older and frail patients, alternative newer chemotherapy regimens should be sought. Patients with deletion 17 should receive alemtuzumab treatment, and allogeneic bone marrow transplantation should be considered.Downloads
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