fludarabine + cyclophosphamide + rituximab + sargramostim

A four-drug chemoimmunotherapy and myeloid growth factor regimen combining nucleoside analog fludarabine, alkylating agent cyclophosphamide, anti-CD20 monoclonal antibody rituximab, and granulocyte-macrophage colony-stimulating factor sargramostim. The FCR backbone is a standard regimen for fit patients with chronic lymphocytic leukemia due to synergistic cytotoxicity and improved PFS/OS versus FC; sargramostim is added to stimulate myelopoiesis and reduce infectious risk by increasing neutrophils and other myeloid cells. Mechanistically: fludarabine inhibits DNA synthesis/repair causing apoptosis; cyclophosphamide crosslinks DNA; rituximab induces B-cell depletion via CDC, ADCC, and apoptosis by targeting CD20; sargramostim activates the GM-CSF receptor to promote proliferation and differentiation of myeloid progenitors and activation of mature granulocytes/macrophages.

Other names

FCR plus sargramostimfludarabine/cyclophosphamide/rituximab plus sargramostimFCR + GM-CSFfludarabine + cyclophosphamide + rituximab + GM-CSF