Rituximab, fludarabine, and cyclophosphamide versus fludarabine and cyclophosphamide for treatment of chronic lymphocytic leukemia: A systematic review with meta-analysis

• The FCR regimen is superior to the FC regimen for patients with CLL regarding to the outcomes complete remission, progression-free survival and overall survival.
• The FCR regimen has more side effects and adverse reactions as neutropenia grade III and IV in comparison at the FC regimen.
• New drugs like Obinutuzumab and Ofatumumab for the treatment of CLL, has not proved to be superior to rituximab.

BackgroundChronic lymphocytic leukemia (CLL) is a disease of the lymphoid system, in which the most common therapy is fludarabine plus cyclophosphamide (FC). The addition of rituximab to FC has been used, a combination known as FCR.ObjectivesTo perform a systematic review with meta-analysis of clinical trials between 2000 and 2012 comparing FC and FCR in patients with CLL.Material and methodsElectronic databases were searched using keywords related to the objectives of this review. The outcomes examined were progression-free survival and complete remission.ResultsThe progression-free survival and the overall survival showed significant difference between the two regimens, with complete remission being more frequent in FCR-treated patients (odds ratio = 2.58; 95% CI: 2.13–3.13). Patients treated with FCR showed significantly higher neutropenia and serious adverse reactions.ConclusionDespite the favorable results of the FCR regimen on outcomes including complete remission, progression-free survival, and overall survival, there is a lack of methodological rigor and appropriate analyses in many of these studies, and thus, there is a need for further studies examining the effect of rituximab in CLL patients.