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Fludarabine 25 mg/m2/d plus cyclophosphamide 250 mg/m2/d were administered intravenously for 3 days with or without oblimersen 3 mg/kg/d as a 7-day continuous intravenous infusion (beginning 4 days before chemotherapy) for up to six cycles. CR/nPR was achieved in 20 (17%) of 120 patients in the oblimersen group and eight (7%) of 121 patients in the chemotherapy-only group (P?=?0.025). Achievement of CR/nPR was correlated with both an extended time to progression and survival (P? http://www.selleckchem.com/products/epz-5676.html of a given http://www.selleck.cn/products/Staurosporine.html CLL a patient becomes a task that requires experience, a good clinical judgment and an appropriate use of diagnostic tools. The following parameters should be considered before recommending a treatment for CLL [41]: The clinical stage of disease. The fitness of the patient. The genetic risk of the leukemia. The treatment situation (first versus second line, response versus non-response of the last treatment). Using the assessment of these 4 parameters, the following recommendations can be given: In a patient with advanced (Binet C, Rai III-IV) or active, symptomatic disease, treatment should be initiated. In this situation, patients need to be evaluated for their physical condition (or comorbidity). For patients in good physical condition (��go go��) as defined by a normal creatinine clearance and a low score at the ��cumulative illness rating scale�� (CIRS) [169], patients should be offered more combination therapies such as FC or FR or FCR. Patients with a somewhat impaired physical condition (��slow go��) may be offered http://www.selleckchem.com/products/ly2109761.html either chlorambucil in combination with an anti-CD20 antibody or a dose-reduced fludarabine containing regimen with a CD20 antibody. The aim of therapy in this situation is symptom control. Patients with symptomatic disease and with del(17p) or TP53 mutations man receive FCR or BR or an alemtuzumab-containing regimen as first-line treatment. In general, these regimen all yield response rates above 50%. These patients respond poorly to fludarabine or fludarabine-cyclophosphamide. Since none of these therapies promises long-lasting responses (except, maybe, ibrutinib), an allogeneic stem cell transplantation should be offered and discussed. Figure 3 summarizes the principles of managing of patients at relapse according to the duration of remission and the physical fitness. As a general rule, the first-line treatment may be repeated, if the duration of the first remission exceeds 12 months (or with the modern chemoimmunotherapies 24 months).