OBJECTIVES: To describe the current pattern of care and resource utilisation in Europe for patients with fludarabine-refractory chronic lymphocytic leukaemia (CLL) who are either refractory to alemtuzumab (DR) or ineligible for alemtuzumab due to bulky lymphadenopathy (BFR) METHODS: Medical charts were reviewed from nine sites in France, Germany, Italy, Spain and the UK. Patient charts with an index diagnosis of DR or BFR between January 2002 and June 2008 were abstracted, with a pre and post-index review period of 6 and 18 months respectively.       RESULTS: Data are from an interim analysis of 37 patients, 62% (n=23) DR and 38% (n=14) BFR. Median time between first diagnosis and index refractory diagnosis was 5.2 years.  Average age was 62.2 (range 41-77), 76% were male and average number of co-morbidities was 2.2. Many patients (59%) died during the post index period with median survival following diagnosis of refractory disease being 6.2 months. In the pre-index period the average number of pharmacotherapy regimens was 0.9 (range 0-3) and in the post-index period 1.4 (range 1-4). During the 24 month review period the most frequent single agent regimens were alemtuzumab (38% patients) and methylprednisolone (19%). Patients receiving combination therapy most frequently received rituximab (43%),  mainly in combination with CHOP (16%), fludarabine/cyclophosphamide (11%), and bendamustine (8%). 89% of patients experienced at least one treatment related adverse event, including infection (76%), anaemia (76%), thrombocytopenia (68%) and neutropenia (62%). Average number of post-index A&E visits was 0.8 and inpatient stays 1.9, the majority (86%) relating to CLL or its treatment. Average inpatient stay was 11.2 days. Most patients (81%) had multiple diagnostic investigations (average 11.5), predominantly CT scans (average 6.1) and X-rays (average 2.0).                  CONCLUSIONS: This study demonstrates the high economic burden and continuing unmet clinical needs of patients with fludarabine-refractory CLL disease in Europe.