Dr. Skarbnik on the Role of Chemotherapy in CLL

Alan Skarbnik, MD, staff physician, Department of Bone Marrow Transplantation and Department of Lymphoma, John Theurer Cancer Center, discusses the use of chemotherapy in patients with chronic lymphocytic leukemia (CLL).

Chemotherapy has a role in select patients. In general, Skarbnik reserves chemotherapy for patients who have a certain cytogenetic profile without complex cytogenetics. This excludes patients with 17p deletion, 11q deletion, and IGHV mutations.

Selected patients seem to have much better responses and much longer progression free survival when receiving chemotherapy. This is especially true in younger patients who receive fludarabine, cyclophosphamide, and rituximab (Rituxan; FCR). Data from researchers at The University of Texas MD Anderson Cancer Center show that patients who have this particular combination of cytogenetics can have remissions longer than 12 years. In older patients who cannot tolerate FCR, bendamustine and rituximab may be an option if they meet those cytogenetic criteria.

Patients who do not meet these criteria should be enrolled in clinical trials or receive ibrutinib (Imbruvica), which is an approved frontline agent in this setting. There is a role for chemotherapy, but it is being minimized, says Skarbnik.