What would you choose as a first line therapy for a patient with CLL who is asymptomatic with Rai Stage 4 with bulky adenopathy and organomegaly?  

A big discriminating feature here would be based upon age. For a patient who is fit and <65-70 years, IGHV mutated disease may be curable with fludarabine, cyclophosphamde, and rituximab therapy, first piloted by Michael Keating's group at MD Anderson Cancer Center. At a median follow up time pe...