Guidelines on Diagnosis and Treatment of Malignant Lymphomas
Guidelines on Diagnosis and Treatment of Malignant Lymphomas
Guidelines on Diagnosis and Treatment of Malignant Lymphomas
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<strong>Treatment</strong><br />
Approximately 25% <strong>of</strong> patients with CLL (ie stable CLL , Binet<br />
stage A) do not require treatment <strong>and</strong> are managed with a watch<br />
<strong>and</strong> wait policy. Indicati<strong>on</strong>s for treatment are progressive stage A<br />
disease or stage B or C CLL.<br />
M<strong>on</strong>otherapy in CLL<br />
Traditi<strong>on</strong>ally CLL was treated with Chlorambucil with symptomatic<br />
intent to c<strong>on</strong>trol progressive disease or B symptoms. Fludarabine<br />
m<strong>on</strong>otherapy results in an increased complete remissi<strong>on</strong> rate <strong>and</strong><br />
l<strong>on</strong>ger treatment free intervals. Bendamustine has been recently<br />
licensed for the treatment <strong>of</strong> CLL resulting in resp<strong>on</strong>se rates <strong>of</strong><br />
59% <strong>and</strong> a median progressi<strong>on</strong> free survival (PFS) <strong>of</strong> 18 m<strong>on</strong>ths.<br />
Combinati<strong>on</strong> treatments<br />
Combined Fludarabine <strong>and</strong> Cyclophosphamide (FC) increases<br />
oS at 5 years from 44% for Chlorambucil <strong>and</strong> 48% for Fludarabine<br />
to 57% for combined FC.<br />
Refractory/ poor risk CLL<br />
Patients who are refractory to Fludarabine, have p53 dysfuncti<strong>on</strong><br />
or deleti<strong>on</strong> <strong>of</strong> 17p have a median survival <strong>of</strong>
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