Susan M. O'Brien, MD, Professor, Department of Leukemia, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, discusses the standard of care for patients with chronic lymphocytic leukemia (CLL).

Healthy and fit patients with CLL are eligible to receive a combination of fludarabine, cyclophosphamide, and rituximab (FCR). Clinical trials have demonstrated that this is the most effective treatment regimen currently available for patients with CLL. The randomized German CLL Study Group, the CLL8 trial, demonstrated an overall survival benefit for the FCR regimen, which was one of the first regimens to demonstrate improved survival in CLL.

The standard chemotherapy regimen is generally ineffective in patients with a 17p deletion, which generally results in an incomplete p53 gene or an allelic mutation in the other arm of chromosome 17. O'Brien notes that there is not a current standard for this population, which makes them eligible for clinical trials and allogeneic transplant at first admission.

FCR may not be considered in elderly patients (over 70) and in those that are not fit. If the disease is aggressive and FCR is needed it should be administered with a dose reduction in elderly patients. Fludarabine is renally excreted and most elderly patients have abnormal kidney function, which can lead to overtreating if the normal dose is given.