Background To determine whether chlorambucil treatment benefits patien
ts with indolent chronic lymphocytic leukemia (CLL), we conducted two
randomized trials in 1535 patients with previously untreated stage A C
LL. Methods In the first trial, 609 patients were randomly assigned to
receive either daily chlorambucil or no treatment; in the second tria
l, 926 patients were randomly assigned to receive either intermittent
chlorambucil plus prednisone or no treatment. Median follow-up for the
first and second trials exceeded 11 and 6 years, respectively. The en
d points were overall survival, response to treatment, and disease pro
gression. Results Treatment of indolent CLL did not increase survival
in either trial. In the treated group, as compared with the untreated
group, the relative risk of death was 1.14 (95 percent confidence inte
rval, 0.92 to 1.41; P=0.23) in the first trial and 0.96 (95 percent co
nfidence interval, 0.75 to 1.23; P=0.74) in the second trial, with 76
percent and 69 percent of patients, respectively, having a response to
therapy. Although chlorambucil slowed disease progression, there was
no effect on overall survival. In the untreated group in the first tri
al, 49 percent of patients did not have progression to more advanced d
isease and did not need therapy after follow-up of more than 11 years;
however, 27 percent of patients with stage A CLL died of causes relat
ed to the disease. Conclusions Chlorambucil does not prolong survival
in patients with stage A CLL. Since deferring therapy until the diseas
e progresses to stage B or C does not compromise survival, treatment o
f indolent CLL is unnecessary. (C) 1998, Massachusetts Medical Society
.