Chlorambucil plus rituximab as front-line therapy for elderly and/or unfit chronic lymphocytic leukemia patients: Correlation with biologically-based risk stratification

First-line treatment for young/fit patients with chronic lymphocytic leukemia (CLL) is the combination of fludarabine, cyclophosphamide and rituximab (FCR), which has improved these patients’ progression-free survival and overall survival,1 but is poorly tolerated by elderly patients or patients with comorbidities.2 Such patients have been historically treated with chlorambucil, which is well tolerated but does not improve survival.3 To improve outcomes, chlorambucil has been combined with anti-CD20 monoclonal antibodies. Three prospective studies4–6 and one retrospective7 one investigated the combination of chlorambucil with rituximab (Chl-R) as front-line treatment for elderly CLL patients or for younger patients unsuitable for fludarabine-based therapies. Overall response rates ranging from 66% to 84% have been reported, with complete response rates of 8–26% and progression-free survival from 16.3 to 34.7 months.