1. 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
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1. Early discussion with RLUH advised