What is the best treatment for relapsed CLL? The MDACC group makes a plea that it is still FCR. In the Blood of 17th March a final report of the large phase II study of FCR in relapsed CLL is made. The overall response rate was 74% and the CR rate 30%. The median overall survival was 47 months and progression-free survival 21 months.
They proposed a hierarchical model of the likelihood of a good response. Patients who were previously exposed to antibody therapy or purine analogues but not to alkylating agents had the highest response rates and survival. Patients who had previous exposure to purine analogues and alkylating agents had a perfectly acceptable respons unless they were refractory to fludarabine. Patients refractory to fludarabine or those who had received more than three previous types of treatment should not be offered FCR.
Drawing from the REACH trial, FCR still seems to have an advantage in patients with del 11q, but obviously not with patients with del 17p.
There were too few data on patients with other modern prognostic markers to draw any conclusions about them.
There are risks with older patients especially in patients who have received prior FCR. Prolonged cytopenias may be more of a risk than from other problems, but from these data it it seems that younger patients who had experienced a remission of at least 3 years are candidates for retreatment with FCR.