Chemoimmunotherapy With Low-Dose Fludarabine and Cyclophosphamide and High Dose Rituximab in Previously Untreated Patients With Chronic Lymphocytic Leukemia

Abstract

FCR-Lite is highly effective in previously untreated CLL patients. Grade 3/4 neutropenia was dramatically reduced compared to standard FCR and our data demonstrated FCR-Lite can be safely administered in the community setting.

Impact of dose intensity on outcome of fludarabine, cyclophosphamide, and rituximab regimen given in the first-line therapy for chronic lymphocytic leukemia

“…Furthermore, these patients benefited from two years of rituximab maintenance and this makes it difficult to interpret the impact of altered RDI on the recently published long-term PFS results. 7,8 Two French randomized studies have now incorporated the concept of high-dose rituximab associated with FC: i) the CLL-2010 FMP study (500 mg To conclude, our study shows that the efficiency of FCR depends on precise modalities of administration. Outside the setting of clinical trials, FCR dose adjustments are frequent because of objective considerations (e.g.…”

“…5,6 More recently, Foon and coworkers have developed the FCR-Lite schedule using low doses of FC in combination with high-dose rituximab. 7,8 Finally, the French CLL study group is currently promoting FCR combination in young or fit elderly patients with oral F 40 mg/m 2 Days 1-3 + C 250 mg/m 2 Days 1-3 + R 375-500 mg/m 2 . From all these studies, it seems that toxicity is more related to the dose rather than to the route of administration.…”

Chlorambucil plus rituximab with or without maintenance rituximab as first‐line treatment for elderly chronic lymphocytic leukemia patients

“…As in other chronic B-cell malignancies, the use of R after induction chemotherapy suggests a benefit in sustaining the response duration in CLL patients [28][29][30][31]. Most of the published studies used R after fludarabine-based regimens; the most recent one after FCR plus mitoxantrone, with a remarkable efficacy but a relevant hematologic Only AE judged clinically relevant and/or more frequent within safety population were selected.…”

Changing paradigms in the treatment of chronic lymphocytic leukemia

“…[58][59][60] If BR, PCR or FCR-Lite have equal efficacy and less toxicity than FCR then they might be preferable front-line treatments; however, currently there is no phase 3 data to support this. Phase 2 data suggests that both FCR-Lite 55 and PCR 59 have considerably less grade 3/4 neutropenia than FCR. 51 Alemtuzumab is also a very effective front-line monotherapy but did not appear to improve the efficacy when combined with FCR 60 and major toxicities were reported when it was used for consolidation therapy.…”

“…55 In this regimen, fludarabine was reduced to 20 mg/m 2 days 2-4 during cycle 1 and days 1-3 in cycle 2-5, cyclophosphamide was reduced to 150 mg/m 2 (same schedule as fludarabine) and rituximab was given on day 1 of cycle 1 at a dose of 375 mg/m 2 and on cycles 2-5 on day 1 at 500 mg/m 2 preceding chemotherapy and on day 14 of each cycle. Maintenance rituximab at 500 mg/m 2 was given every 3 months until progression.…”