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Chronic Lymphocytic Leukemia Case Studies

Case Studies: The Therapeutic Approach for High-Risk CLL

In this case-based interview, John F. Gerecitano, MD, PhD, reviews the case of a young male patient with high-risk chronic lymphocytic leukemia and nodal involvement, and provides his insight on how to manage this patient’s treatment approach.

The Therapeutic Approach for High-Risk CLL

Case:  A Young Male Patient with High-Risk CLL and Nodal Involvement

January 2017

  • A 53-year-old male presents with fatigue, night sweats, and swollen glands
  • PMH: hypertension managed with losartan
  • PE: left axillary and bilateral cervical adenopathy, 4 cm X 3 cm
  • Laboratory findings:
    • WBC; 117.3 X 109/L
    • Lymphocytes; 109.2 X 109/L
    • Hb; 9.6 g/dL
    • Platelets; 174 X 109/L
    • ANC; 1,950/mm3
    • LDH 160 U/L
  • Flow cytometry; CD19++, CD5+, CD20+, CD23++, CD38+
  • BM; CLL in 86% of cells
  • IgVH mutated
  • Cytogenetics by FISH; del17p
  • Diagnosis; chronic lymphocytic leukemia
  • The patient was treated with FCR and achieved a partial response to therapy after 6 cycles
    • Left axillary lymph node, 2 cm X 2 cm
    • Lymphocytes; 10 X 109/L
    • Symptoms resolved
  • The patient was started on maintenance therapy with lenalidomide

December 2017

  • The patient complained of increasing bouts of extreme fatigue, abdominal bloating and intermittent moderate to severe abdominal pain
  • PE:
    • Bulky adenopathy in the cervical and axillary lymph nodes, inguinal lymphadenopathy
    • Fluid wave test positive for ascites
  • Abdominal CT showed multi-station bulky lymphadenopathy, hepatomegaly, and splenomegaly
  • Patient underwent large-volume paracenteses, ascites sampling positive for CLL involvement
  • Laboratory findings:
    • WBC; 84,000, 97% lymphocytes
    • Hb; 9.4 g/dL
    • Platelets; 110,000/mm3
    • ANC; 1,600/mm3 (WNL)
    • LDH; 262 U/L
    • Beta-2-microglobulin; 8.9 µg/L
  • The patient was started on venetoclax
  • The patient developed grade 3 neutropenia after 4 weeks on therapy which was managed and later resolved


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