Efficacy of combination of rituximab therapy with chlorambucil plus prednisolone (R-LP) Protocol as treatment line in chronic lymphocytic leukemia patients


Background: Chronic lymphocytic leukemia (CLL) remains an incurable disease withvariable course. It is typically responsive to several courses of chemotherapy.Objectives: Evaluation of efficacy of combination of rituximab with chlorambucil plusprednisolone (R-LP) as first line of treatment of CLL patients whom are not fit for treatmentwith fludarabine combination therapy.Patients & Method: Over 17 months duration, thirty patients with CLL were included in thisa cohort prospective study. All of them were received 8 cycles combinations of rituximab(day 1) plus chlorambucil plus predinsolon (day1 to day 5). It had been used for thosecouldn’t receive or those having intolerance to fludarabin based therapy. At end of courses ,re-assessment had performed & included clinical examination ,blood count in addition to BMexamination for evaluation of response in term of overall response rate(ORR) ,duration ofresponse(DOR), and treatment free interval(TFI).Results: Overall response rate (ORR) reported in 86.67% of patients. Both anemia &bonemarrow lymphocyte percentage has significant relation to the treatment response (p=0.051,p=0.036 respectively) as well as positive direct antiglobulin test( DAT) & diffuse BMinfiltration (p=0.033,p=0.04 respectively). Mean duration of response (DOR) is 9.23+0.50months while mean treatment free interval (TFI) is 11.74+0.64 months. Bone marrowlymphocyte proportion is consistently predictive factor in long term remission durability innegative correlation( r = – 0.47, p= 0.04).Conclusion: Rituximab plus chlorambucil and predinsolon (R-LP) combination therapymight be as good alternative regimen with equivalent response for CLL patients whom arenonsuitable for treatment with fludarabine combination therapy