Introduction: Due to the high cost of targeted therapy, chemoimmunotherapy regimens remain the standard therapy for chronic lymphocytic leukemia in many developing countries. In this study, we compare the treatment outcomes of the two main chemoimmunotherapeutic regimens.

Material and methods: Data was obtained from the oncology department archives at Tishreen University Hospital between 2016 and 2020. We enrolled previously untreated, fit patients with chronic lymphocytic leukemia who were treated with one of two regimens: either a fludarabine, cyclophosphamide, and rituximab regimen, or a bendamustine and rituximab regimen.

Results: 78 patients were enrolled in the study. 56.8% of the fludarabine, cyclophosphamide, and rituximab group achieved complete response versus 73.5% of the bendamustine and rituximab group. Progression-free survival was slightly shorter for fludarabine, cyclophosphamide, and rituximab than for bendamustine and rituximab [median 15.1 months [95% confidence interval {CI} 12.4–17.8] vs. 17.7 months (95% CI 15.4–20.1)] without statistical significance. In elderly patients (>65 years) median progression-free survival (PFS) was significantly (p = 0.046) longer with the bendamustine and rituximab treatment [median 19.9 months (95% CI 17.2–22.5)] than with the fludarabine, cyclophosphamide, and rituximab [median 11.6 months (6–17.2)]. Regarding overall survival, no significant difference between the two groups was documented. Delay and deletion of cycles, neutropenia and anemia were more frequent with the fludarabine, cyclophosphamide, and rituximab group. Furthermore, we found that elevated lactate dehydrogenase, positive expression of ZAP-70, stage C, and splenomegaly are all indicators of poor prognosis in correlation with PFS.

Conclusions: Our study found that the bendamustine and rituximab regimen is safer than, and has comparable efficacy to, the standard therapy of fludarabine, cyclophosphamide, and rituximab for previously untreated, fit patients with chronic lymphocytic leukemia.