Cancers & treatments·Regimen libraryFirst line

Chlorambucil-prednisone (C+P)

Checked 2026-09-09

Historic first-line treatment for symptomatic, advanced chronic lymphocytic leukaemia, given every two weeks and continued to maximal response; superseded by fludarabine combinations, chlorambucil-obinutuzumab and the BTK and BCL2 inhibitors

Also called Chlorambucil and prednisone, C+P, CHLORAMBUCIL-PREDNISONE, Intermittent chlorambucil-prednisone.

One cycle

every 14 days

14-day cycle, to maximal response, up to 18 monthsOral Daily oral course

Components

Drug	Dose	Route	Days	Note
Chlorambucil Alkylating agent (nitrogen mustard)	30 mg/m²	Oral	D1
Prednisone Glucocorticoid	80 mg once daily	Oral	D1-5

Cycles

to maximal response, up to 18 months

14-day cycle

Emetogenicity

Low (10-30%)

G-CSF

Not routine

Notes

In the ECOG trial of 122 patients, C+P and the more intensive CVP gave the same survival, complete remission rate and duration of response, so the gentler regimen stayed the standard for advanced CLL in the 1990s.
Continuing treatment until the best response, rather than intensifying it, was credited with the long survival seen; toxicity was modest despite prolonged treatment.
Today chlorambucil survives mainly as the chemotherapy partner of obinutuzumab (CLL11) and as a comparator in trials of targeted drugs.

Used in

Chronic lymphocytic leukaemia

Products

ChlorambucilPrednisone

Source

Raphael (ECOG), JCO 1991: intermittent chlorambucil-prednisone versus CVP in advanced CLL

Reference doses for a typical adult from the cited protocol or label. Doses are adjusted for renal and hepatic function, age, performance status and prior toxicity, and institutional protocols vary. Verify against the current label and your local protocol before treating. Not medical advice.