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Chronic Lymphocytic Leukemia Case Studies

Case Studies: Relapsed Chronic Lymphocytic Leukemia

Ian W. Flinn, MD, PhD, examines the case of a patient with chronic lymphocytic leukemia who relapsed after being treated with frontline ibrutinib, and considers the various mono- and combination treatment options for this setting.

Relapsed Chronic Lymphocytic Leukemia

A 71-Year-Old Man With CLL

  • A 71-yearold man presented with symptoms of persistent fatigue and weight loss
  • PMH: Left axillary lymph node, 1.5 cm X 1.5 cm
  • PE: Left axillary lymph node, 1.5 cm X 1.5 cm
  • Laboratory findings:
    • WBC, 133,000; 85% lymphocytes (ALC, 68,000 cells/mL)
    • Hb; 11.4 g/dL
    • Platelets; 111 X 109/L
    • ANC; 174/mm3
  • Molecular testing:
    • Flow cytometry; CD19++, CD5+, CD20+, CD23++, CD38+
    • IgVH mutated
    • FISH, +12
  •  β2M, 3.0 mg/L
  • Diagnosis; chronic lymphocytic leukemia
  • BM biopsy; CLL in 88% of cells
  • The patient was treated with ibrutinib and achieved a complete remission within 5 months
  • 13 months later, the patient reported extreme fatigue; now with 3.0 X 3.0-cm lymph node
  • Laboratory findings:
    • Repeat FISH: remained +12
    • WBC, 225 X 109/L
    • HB, 9.6 g/dL
    • Platelets, 103 X 109/L
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