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Abstract
Chronic lymphocytic leukemia (CLL) is a neoplastic disease characterized by the accumulation of small mature appearing lymphocytes in the blood, marrow, and lymphoid tissues, treatment of CLL is moving from the era of watchful waiting and palliative treatment to an aggressive approach, with the new therapeutic end points of achieving a complete remission and minimal residual disease, using novel agents singly or in combination (Rai, 1999).
Patients with CLL can relapse even after aggressive therapy and autografts. It is commonly assumed that to prevent relapse the level of minimal residual disease (MRD) should be as low as possible. To evaluate MRD, highly sensitive quantitative assays are needed (Pekova et al., 2005).
Several phase III studies have firmly established fludarabine as the first -line treatment for symptomatic, untreated patients with CLL (Rai et al., 1996; Johnson, et al., 1996; Leporrier et al., 1997). It was found that fludarabine and cyclophosphamide is a highly active and well-tolerated regimen with an acceptable level of toxicity in patients with previously untreated CLL (Flinn et al., 1998).