Refining chemotherapy for chronic lymphocytic leukaemia with targeted drugs

Abstract

The triple combination regimen of fludarabine, cyclophosphamide, and rituximab (FCR) has been a cornerstone of frontline treatment of young fit patients with chronic lymphocytic leukaemia.1 It produces long-term remissions, including complete remissions with undetectable minimal residual disease.2,3 However, this treatment also leads to high-grade toxicity, including longlasting neutropenia with the risk of late-onset infection and secondary malignancies. Furthermore, patients with unmutated IGHV have only limited benefit from this aggressive treatment, which results in only a few years of progression-free survival in this subgroup.