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 with variable course. It is typically responsive to several courses of chemotherapy. Objectives: Evaluation of efficacy of combination of rituximab with chlorambucil plus prednisolone (R-LP) as first line of treatment of CLL patients whom are not fit for treatment with fludarabine combination therapy. Patients & Method: Over 17 months duration, thirty patients with CLL were included in this a 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 those couldn′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 BM examination for evaluation of response in term of overall response rate(ORR) ,duration of response(DOR), and treatment free interval(TFI). Results: Overall response rate (ORR) reported in 86.67% of patients. Both anemia &bone marrow 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 BM infiltration (p=0.033,p=0.04 respectively). Mean duration of response (DOR) is 9.23 + 0.50 months while mean treatment free interval (TFI) is 11.74 + 0.64 months. Bone marrow lymphocyte proportion is consistently predictive factor in long term remission durability in negative correlation( r = - 0.47, p= 0.04). Conclusion: Rituximab plus chlorambucil and predinsolon (R-LP) combination therapy might be as good alternative regimen with equivalent response for CLL patients whom are nonsuitable for treatment with fludarabine combination therap