NICE recommends taking rituximab, fludarabine and cyclophosphamide together as a possible treatment for some people with relapsed or refractory chronic lymphocytic leukaemia (see below).

Who can have rituximab?

You should be able to have rituximab, fludarabine and cyclophosphamide together unless:

  • you have had rituximab before (see below) or
  • you have had fludarabine before and your condition did not respond to it or worsened within 6 months of treatment.

If you have had rituximab before

If this was part of a research study and one of the following conditions applies, you should still be able to have rituximab, fludarabine and cyclophosphamide together:

  • the dose of rituximab you had was lower than normally used to treat chronic lymphocytic leukaemia or
  • you had rituximab with other chemotherapy instead of fludarabine and cyclophosphamide.

If the conditions described above do not apply, you should only have rituximab again if you are taking part in a research study.

Rituximab with other chemotherapy

If your healthcare professional thinks that rituximab with other chemotherapy instead of fludarabine and cyclophosphamide is appropriate for you, you should only have rituximab if you are taking part in a research study.

Your responsibility

The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.

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