title: Rituximab, fludarabine, and cyclophosphamide versus fludarabine and cyclophosphamide for treatment of chronic lymphocytic leukemia: A systematic review with meta-analysis.
abstract: BACKGROUND
  Chronic 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.
  
  
  OBJECTIVE
  To perform a systematic review with meta-analysis of clinical trials between 2000 and 2012 comparing FC and FCR in patients with CLL.
  
  
  METHODS
  Electronic databases were searched using keywords related to the objectives of this review. The outcomes examined were progression-free survival and complete remission.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Despite 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.
authors: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil. Electronic address: altacilio@fmrp.usp.br.
authors: Altacílio Aparecido
authors: AA
authors: Nunes
authors: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors: Anderson Soares
authors: AS
authors: da Silva
authors: General Coordination of Health Technology Assessment, Department of Science and Technology (DECIT), Ministry of Health, Brasília, Brazil.
authors: Kathiaja Miranda
authors: KM
authors: Souza
authors: General Coordination of Health Technology Assessment, Department of Science and Technology (DECIT), Ministry of Health, Brasília, Brazil.
authors: Christine de Nazaré Silva
authors: Cde N
authors: Koury
authors: Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
authors: Luane Marques
authors: LM
authors: de Mello
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D000069283:Rituximab; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine
keywords: Chronic lymphocytic leukemia; Cyclophosphamide; Fludarabine; Meta-analysis; Rituximab