NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

40 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2018 4 Treatment guide CLL without del(17p) or TP53 mutation Guide 5 lists first-time treatment options for younger, healthy people with CLL that isn’t missing parts of chromosome 17 or has a TP53 mutation. FCR is the standard of care. FCR has been tested in well-designed clinical trials and has had good results for younger people with CLL. Other options include those drugs listed in Guide 5. These options include chemotherapy and targeted therapy drugs. The treatment options are listed in order of preference of NCCN experts. After first-line treatment, your doctor may consider maintenance therapy with lenalidomide if you are at high risk for the disease to relapse (return). Your doctor will test for MRD after first-line treatment. MRD is when a very small amount of leukemia cells remains in your body after a course of treatment. With MRD, the amount of leukemia cells left is too small to be seen with a microscope. Thus, further treatment may be given. Guide 5. First-time treatments including purine analogs Younger and fairly healthy Treatment options (best options listed first) • FCR • Ibrutinib • FR ( f ludarabine, r ituximab) • Bendamustine ± CD20 monoclonal antibody • HDMP + rituximab • PCR ( p entostatin, c yclophosphamide, r ituximab)