open access

Vol 4, No 2 (2013)
Review paper
Published online: 2013-06-25
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Chronic lymphocytic leukemia „slow-go”: what does it mean and how to treat it?

Dariusz Stanisław Wołowiec, Anna Korycka-Wołowiec
Hematologia 2013;4(2):85-96.

open access

Vol 4, No 2 (2013)
REVIEW ARTICLES
Published online: 2013-06-25

Abstract

Immunochemotherapy with fludarabine, cyclophosphamide and rituximab (FCR) is currently considered the most efficacious treatment in advanced/progressive chronic lymphocytic leukemia (CLL). However, a significant proportion of CLL patients are unfit for this protocol due to either contraindications for fludarabine (impaired renal function or active haemolysis) or significant comorbidities. Fludarabine should be also given with caution to elderly persons. Patients who should be proposed any form of chemotherapy but cannot be given full-dose fludarabine-based regimens are collectively named “slow-go”. There are no generally admitted therapeutical guidelines for these patients, all the more that very few studies were specifically dedicated to elderly CLL patients. Chlorambucil (Chl) remains for them the treatment of reference, but the overall response rate is relatively low and complete remissions are exceptional.  Bendamustin alone or with rituximab seems to be a reasonable alternative to Chl because of higher response rates and longer progression-free survival, however at the expense of somewhat higher hematological toxicity. Low-dose fludarabin-based regimens, e.g. “FCR-lite” give also promising results, but their impact on the survival is to be established. Other therapeutical options to be taken into consideration are pentostatin- or high-dose methylprednisolon-containing protocols. The usefulness of the addition of rituximab or novel anti-CD20 antibodies (ofatumumab) to Chl is under studies.

Abstract

Immunochemotherapy with fludarabine, cyclophosphamide and rituximab (FCR) is currently considered the most efficacious treatment in advanced/progressive chronic lymphocytic leukemia (CLL). However, a significant proportion of CLL patients are unfit for this protocol due to either contraindications for fludarabine (impaired renal function or active haemolysis) or significant comorbidities. Fludarabine should be also given with caution to elderly persons. Patients who should be proposed any form of chemotherapy but cannot be given full-dose fludarabine-based regimens are collectively named “slow-go”. There are no generally admitted therapeutical guidelines for these patients, all the more that very few studies were specifically dedicated to elderly CLL patients. Chlorambucil (Chl) remains for them the treatment of reference, but the overall response rate is relatively low and complete remissions are exceptional.  Bendamustin alone or with rituximab seems to be a reasonable alternative to Chl because of higher response rates and longer progression-free survival, however at the expense of somewhat higher hematological toxicity. Low-dose fludarabin-based regimens, e.g. “FCR-lite” give also promising results, but their impact on the survival is to be established. Other therapeutical options to be taken into consideration are pentostatin- or high-dose methylprednisolon-containing protocols. The usefulness of the addition of rituximab or novel anti-CD20 antibodies (ofatumumab) to Chl is under studies.

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Keywords

chronic lymphocytic leukemia, chlorambucil, fludarabine, rituximab, bendamustine

About this article
Title

Chronic lymphocytic leukemia „slow-go”: what does it mean and how to treat it?

Journal

Hematology in Clinical Practice

Issue

Vol 4, No 2 (2013)

Article type

Review paper

Pages

85-96

Published online

2013-06-25

Bibliographic record

Hematologia 2013;4(2):85-96.

Keywords

chronic lymphocytic leukemia
chlorambucil
fludarabine
rituximab
bendamustine

Authors

Dariusz Stanisław Wołowiec
Anna Korycka-Wołowiec

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