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Table 1 NCCN-suggested treatment regimensa for CLL [10]

From: Therapeutic potential of new B cell-targeted agents in the treatment of elderly and unfit patients with chronic lymphocytic leukemia

Setting Younger/fit patientsb Elderly/physiologically unfit patientsc
First-line therapy Chemoimmunotherapy Obinutuzumab + chlorambucil
 FCR Ofatumumab + chlorambucil
 FR Rituximab + chlorambucil
 PCR Bendamustine ± rituximab
 Bendamustine ± rituximab Obinutuzumab
Fludarabine ± rituximab
Relapsed/refractory therapy (short response)d Ibrutinib Ibrutinib
Idelalisib ± rituximab Idelalisib ± rituximab
Chemoimmunotherapy Chemoimmunotherapy
 FCR  Reduced-dose FCR
 PCR  Reduced-dose PCR
 Bendamustine ± rituximab  Bendamustine ± rituximab
 Fludarabine ± alemtuzumab  HDMP + rituximab
 RCHOP  Rituximab + chlorambucil
 OFAR Ofatumumab
Ofatumumab Obinutuzumab
Lenalidomide ± rituximab Lenalidomide ± rituximab
Alemtuzumabe ± rituximab Alemtuzumabe ± rituximab
HDMP + rituximab Dose-dense rituximab
  1. CLL chronic lymphocytic leukemia, FCR fludarabine, cyclophosphamide, and rituximab, FR fludarabine and rituximab, HDMP high-dose methylprednisolone, NCCN National Comprehensive Cancer Network, OFAR oxaliplatin, fludarabine, cytarabine, and rituximab, PCR pentostatin, cyclophosphamide, and rituximab, RCHOP rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone
  2. aCLL without del 11q or del 17 p; regimens are listed in order of preference
  3. bAge <70 years, or older patients without significant comorbidities
  4. cAge ≥70 years, or younger patients with comorbidities
  5. dIn patients with long response, suggested to re-treat as in first-line therapy until short response
  6. eAlemtuzumab is no longer commercially available for CLL