NICE has recommended that people with B-cell chronic leukaemia (CLL) who have had to stop their first chemotherapy treatment (for example because it was causing side effects or becasue their disease had progressed), may be treated with fludarabine tablets. Fludarabine may be introduced at the stage where poeple with CLL have previously been offered one of the following treatments:
- cyclophosphamide, doxorubicin, and prednisolone (CHOP)
- cyclophosphamide, doxorubicin and prednisolone (CAP), or
- cyclophosphamide, vincristine and prednisolone (CVP)
People with CLL should only be given fludarabine by a drip when their condition is such that they are unable to take the tablets.
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.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.