Use of Bendamustine in Chronic Lymphocytic Leukaemia Patients with Co-morbidities

Chronic lymphocytic leukaemia (CLL) is the most common adult leukaemia and mainly affects older patients. First-line treatments for 'fit' (go go) and 'unfit' (no go) CLL patients are well defined, in the form of fludarabine–cyclophosphamide–rituximab (FCR) combination chemoimmunotherapy and best supportive care, respectively. However, the majority of CLL patients fall between these two extremes (slow go patients), nevertheless the standard of care for these patients is not well defined. Recent data suggest that bendamustine chemotherapy may be a good option in this group. In a recent Phase III study, significant improvements in overall response rate, complete response and progression-free survival were reported with bendamustine compared with chlorambucil. Chlorambucil plus rituximab has been shown to induce high responses in elderly CLL patients with a relatively low complete response rate. Bendamustine plus rituximab, and reduced-dose fludarabine plus cyclophosphamide plus high-dose rituximab have demonstrated promising efficacy, but have not been evaluated in elderly CLL patients. Several trials are also ongoing evaluating novel cytostatic agents, combination chemotherapy and chemoimmunotherapy regimens in elderly patients.