I think it is generally believed that fludarabin monotherapy does not improve overall survival compared to classic therapy chlorambucil monotherapy. Then, does chlorambucil monotherapy improve overall survival compared to non-treated patients? I have not found such a clinical trials, but found an old scientific paper on the clinical trial of effects of chlorambucil monotherapy on 612 patients (CLL stage A) (Bood, Vol. 75, 1414-1421, 1990). Surprisingly this study showed that chlorambucil treated patients reduced overall survival. In this paper, authors described that ‘Chlorambucil has been the most common treatment in CLL for 30 years although its beneficial role has never been proved’. I think that these indicates that fludarabin monotherapy does not improve overall survival compared to non-treated patients.
I hear that now chlorambucil monotherapy is used for older patients, because it is mild drug. If overall survival is not extended by chlorambucil monotherapy, what is the benefit? Improve quality of life by a temporary remission?