Chlorambucil Versus Fludarabine

Introduced into clinical practice in the early 1960s, chlorambucil (CLB) is an orally administered alkylating agent with significant activity against CLL. In two prospectives, randomized trials of CLB versus observation in patients with asymptomatic, low-risk disease, the overall response (OR) rates to CLB 0.1 mg/kg daily or 0.3 mg/kg for 5 days monthly were 76% and 69%, respectively.1 More recently, a randomized trial of CLB 20 mg/m2 every 28 days versus fludarabine (FLU) 25 mg/m2 daily for 5 days monthly for 6 months in patients with symptomatic CLL showed an advantage for FLU versus CLB in response rate and progressionfree survival (PFS).2 The results of this study largely relegated CLB to the treatment of older and more infirm patients who were felt to be unable to tolerate FLU.

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