A recent study published in the Journal of Clinical Oncology, which includes among its authors Drs Kanti Rai and John Byrd, found chlorambucil is an acceptable treatment for many older patients with CLL and suggest rituximab is beneficial regardless of age:
"Results: A total of 663 patients were evaluated for response, progression-free survival (PFS), and overall survival (OS) by age group. Interaction effects of fludarabine versus chlorambucil by age group showed that among patients younger than 70 years, PFS and OS was improved with fludarabine over chlorambucil , but not in older adults. In contrast, Fludarabine/Rituximab (FR) improved outcomes relative to fludarabine, irrespective of age. Alemtuzumab consolidation did not provide benefit over similar regimens without alemtuzumab, irrespective of age."