Fink et al identified factors associated with a poor outcome for a patent with CLL following therapy with fludarabine, cyclophosphamide and rituximab (FCR). These can help to identify a patient who may require more aggressive therapy. The authors are from multiple institutions in Germany, Austria, Switzerland and the Czech Republic.

Patient selection: CLL with any tumor cells following therapy with fludarabine, cyclophosphamide and rituximab (FCR)


Outcome: progression-free survival (PFS)



(1) minimal residual disease (MRD): any residual CLL cells

(2) mutation status for IGHV gene


MRD is quantified based on the number of CLL cells per 10,000 leukocytes on 4-color flow cytometry or quantitative PCR.



Number CLL Cells per 10,000 Leukocytes



< 1

< 10^(-4)


1 to 99

>= 10^(-4) to < 10^(-2)


>= 100

>= 10^(-2)


Criteria for poor progression-free survival following FCR:

(1) high MRD

(2) intermediate MRD and unmutated IGHV gene

(3) presence of TP53 aberrations (loss or mutation indicates an ultra-high-risk patient).

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