Sandbox:haytham1

Initial patients evaluation

History Physical examination Complete blood count

Staging

Rai Staging System Binet Staging System

Rai stage 3-4 Binet stage B-C

Rai stage 0-2 Binet stage A

Evaluate patients by cumulative index illness rating scale

Patients managed by observation and close follow-up

Frail patients (CIRS ≥6)

Fit patients (CIRS <6)

Retixumab/obinutuzumab AND chlorambucil

FISH chromosomal analysis

Immunochemotherapeutic regimens for management of patients without chromosome 17p deletion or chromosome 11q deletion here

Immunochemotherapeutic regimens for management of patients with chromosome 17p deletion

Immunochemotherapeutic regimens for management of patients with chromosome 11q deletion

Patients Age

Age <70 years

Age ≥70 years

chemotherapy

Immunochemotherapeutic regimens for management of patients without chromosome 17p deletion or chromosome 11q deletion

Bendamustine + Rituximab Chlorambucil Chlorambucil + PredniSONE Cladribine Cyclophosphamide/PredniSONE Cyclophosphamide/PredniSONE + Rituximab FCR (Fludarabine/Cyclophosphamide + Rituximab) Fludarabine FR (Fludarabine + Rituximab) MethylPREDNISolone (Pulse) PCR (Pentostatin/Cyclophosphamide + Rituximab) Rituximab

Immunochemotherapeutic regimens for management of patients with chromosome 17p deletion

Alemtuzumab + Rituximab Bendamustine + Rituximab FCR (Fludarabine/Cyclophosphamide + Rituximab) FR (Fludarabine + Rituximab) HDMP (High-Dose Methylprednisolone) + Rituximab

Immunochemotherapeutic regimens for management of patients with chromosome 11q deletion

Bendamustine + Rituximab Chlorambucil Chlorambucil + PredniSONE Cyclophosphamide/PredniSONE Cyclophosphamide/PredniSONE + Rituximab FCR (Fludarabine/Cyclophosphamide + Rituximab) PCR (Pentostatin/Cyclophosphamide + Rituximab) Reduced-dose FCR (Fludarabine/Cyclophosphamide + Rituximab) Rituximab