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Although in recent years chemoimmunotherapeutic combinations such as fludarabine, cyclophosphamide, and rituximab have induced response rates of 95% in previously untreated patients and increased the rates of failure\u2010free survival, CLL remains incurable for many patients because of a lack of disease response or the development of refractoriness to fludarabine. Fludarabine\u2010refractory disease is defined as CLL that does not respond to fludarabine or that recurs within 6 months of treatment with a fludarabine\u2010containing regimen. The natural course of the disease is associated with poor survival. Salvage therapeutic strategies include alemtuzumab\u2010containing regimens, targeted agents, and allogeneic stem cell transplantation. Single\u2010agent alemtuzumab induces response in up to 40% of patients with fludarabine\u2010refractory CLL, but responses are not durable, and the median survival is approximately 1 to 2 years. Alemtuzumab is also combined with fludarabine, cyclophosphamide, and\/or rituximab, and other agents such as lenalidomide and flavopiridol, as well as targeted agents, and used in fludarabine\u2010refractory CLL. Cumulative evidence suggests that allogeneic stem cell transplantation is an efficacious therapeutic strategy for patients who do not respond to fludarabine or who develop disease recurrence within 12 months after purine analog treatment. In conclusion, chemoimmunotherapy regimens that include alemtuzumab and\/or rituximab and allogeneic stem cell transplantation improve the prognosis of this disease, but there is a continued need for novel, more effective therapies. Cancer 2009. \u00a9 2009 American Cancer Society.<\/jats:p>","DOI":"10.1002\/cncr.24329","type":"journal-article","created":{"date-parts":[[2009,4,28]],"date-time":"2009-04-28T15:43:41Z","timestamp":1240933421000},"page":"2824-2836","source":"Crossref","is-referenced-by-count":50,"title":["Treatment of fludarabine\u2010refractory chronic lymphocytic leukemia"],"prefix":"10.1002","volume":"115","author":[{"given":"Apostolia\u2010Maria","family":"Tsimberidou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Keating","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2009,4,28]]},"reference":[{"key":"e_1_2_21_2_2","first-page":"1350","volume-title":"Hematology. 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