"In today's CLL climate, web informed patients are rebelling against FCR - and in many cases, I think it is for good reason. FCR is a tough regimen. Even in the German CLL8 study, about 4% of patients die in the first 12 months after starting therapy. In the MD Anderson data set, it appears that unusual infections are increased as far out as two years from therapy. The long term risk of marrow compromise and secondary cancers is real.
But.... In appropriately selected patients, it is probably all worth it
I think these subgroups (IgVH mutated WITH either Trisomy 12, or Del 13Q) have high likelihood of super long term disease control if not cure.
For patients with CLL who need therapy, it is imperative to test for FISH and for anyone considering intensive chemoimmunotherapy - IgHV mutation analysis is a must. For patients less than age 65 with IgHV mutated CLL and either trisomy 12 or del 13Q, should seriously consider FCR as these groups have exceptionally high rates of progression free survival (like about 90% and I believe many of these will prove to be cured)." (My emphasis.)
Full article on Dr Jeff Sharman's Blog: