Treatment guidelines - Chronic Lymphocytic Leukaemia All patients should be considered for available clinical trials 17p- status should be checked prior to each line of therapy Clinical scenario Fit patients Fit for full-dose R-FC Less fit patients Fit for full-dose Chl but not R-FC Unfit patients Not fit for full-dose Chl Asymptomatic stage A Watch & wait or RESPeCT (high-risk: lenalidomide) / CLEAR (low-risk: antibiotics) Watch & wait Progressive first line (no 17p-) R-FC (R-B if F contraindicated due to renal failure or AIHA) AdMIRe (R-FC v R-FCM) ARCTIC (R-FC v miniR-FCM) Chl at dose used in CLL4 Or bendamustine Or RIAltO (O-Chl v O-bendamustine) Low-dose chlorambucil and/or prednisolone Relapsed/refractory (no 17p-) if >2y since R-FC: R-B If 1-2y since R-FC, R-B & consider allograft If >2 years since Chl: Chl If <2 years since Chl: R-B or attenuated R-FC Progressive high-risk (17p- or < 1y since FC)1 CLL210 (CamDexRev) or alemtuzumab or CamPred / CamDex if LN > 2cm. Ofatumumab if refractory to alemtuzumab. Consolidation allograft for fit patients Prednisolone Maintenance for patients in CR/PR CLARET (MRD-guided alemtuzumab v no treatment starting 6-12 months after frontline induction) CONTINUUM (lenalidomide or placebo 2-4 months after second-line induction – must have had prior F) Not applicable Written by: Professor Andrew Pettitt, RLBUHT; agreed haematology CNG Nov 2011; for review Nov 2012 Page 1 of 1 1. Early discussion with RLUH advised