FCR or BR in Patients With Previously Untreated B-Cell Chronic Lymphocytic Leukemia

DISEASE CHARACTERISTICS:

• Confirmed diagnosis of B-cell chronic lymphocytic leukemia (CLL) meeting 1 of the following criteria:

• Binet stage C disease or stage B or A disease requiring treatment

• Binet stage B or A disease meeting ≥ 1 of the following:

• B-symptoms (e.g., night sweats, weight loss ≥ 10% within the past 6 months, fevers > 38°C or 100.4°F for ≥ 2 weeks without evidence of infection) or constitutional symptoms (e.g., fatigue)

• Progressive lymphocytosis, defined as peripheral lymphocyte count > 5 x 10^9/L (i.e., > 50% increase over a 2-month period or doubling of peripheral blood lymphocyte count < 6 months)

• Evidence of progressive marrow failure as manifested by the development/worsening of anemia and/or thrombocytopenia

• Massive, progressive, or painful splenomegaly or hypersplenism

• Massive lymph nodes or lymph node clusters (> 10 cm in longest diameter) or progressive or symptomatic lymphadenopathy

• No 17p deletion by FISH

• No aggressive B-cell cancer, such as Richter syndrome

PATIENT CHARACTERISTICS:

• WHO performance status 0-2

• Life expectancy ≥ 6 months

• Total bilirubin ≤ 2 times upper limit of normal (ULN) (unless directly attributable to CLL)

• AST and ALT ≤ 2 times ULN (unless directly attributable to CLL)

• Creatinine clearance ≥ 70 mL/min (creatinine clearance is to be calculated only in patients with serum creatinine ≥ 1.1 mg/dL)

• Not pregnant or nursing

• Negative pregnancy test

• Fertile patients must use effective contraception during and for ≥ 6 months after completion of study therapy

• Hepatitis B and C negative

• HIV negative

• CIRS score > 6 or a single score of 4 for one organ category

• No active secondary malignancy requiring treatment, except basal cell carcinoma or malignant tumor curatively treated by surgery, or successfully treated secondary malignancies in complete remission > 5 years prior to enrollment

• No history of anaphylaxis following exposure to monoclonal antibodies

• No active bacterial, viral, or fungal infection

• No medical condition requiring prolonged use of oral corticosteroids (i.e., > 1 month)

• No cerebral dysfunction or legal incapacity

• No circumstance that would preclude completion of the study or the required follow-up

PRIOR CONCURRENT THERAPY:

• No prior CLL specific-chemotherapy, radiotherapy, and/or immunotherapy

• Prednisolone administered immediately prior to initiation of study therapy allowed for very high lymphocyte counts

• No concurrent participation in another clinical trial