Chemoimmunotherapy for chronic lymphocytic leukemia.

摘要: To the Editor: Goede et al. (March 20 issue)1 report improved outcomes in patients with chronic lymphocytic leukemia (CLL) and coexisting conditions who received obinutuzumab combination chlorambucil. This conclusion is flawed because of underdosing In Germany, chlorambucil licensed for treatment CLL starting at 0.4 mg per kilogram body weight every other week, gradual increases increments 0.1 until there a clinical response or toxicity. The study, however, used fixed dose 0.5 week without escalation. escalation based on earlier data by Knospe al.,2 described remission rate 61% among untreated CLL; this higher than 31.4% reported colleagues median maximum 0.90 (range, 0.40 to 1.83). So far, no dosing schedule has been shown be superior. cite study that compared fludarabine.3 planned chlorambucil, kilogram, was not performed most patients; thus only week. similar progression-free survival fludarabine groups cannot justify lowering an established approved regimen. We believe treating control below therapeutic standard jeopardizes validity results and, moreover, violates rules Declaration Helsinki new intervention must tested against “the best proven intervention.” 4 Jurgen Spehn, M.D.