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Chronic Lymphocytic Leukemia Case Studies

Case Studies: Treatment for Relapsed Chronic Lymphocytic Leukemia

Nicole Lamanna, MD, discusses the treatment options and potential toxicity profiles for a patient with relapsed chronic lymphocytic leukemia, with particular consideration of the novel therapy venetoclax and rituximab.

Treatment for Relapsed Chronic Lymphocytic Leukemia

A 58-Year-Old Man With Relapsed CLL

  • A 58-yearold man presented with symptoms of fatigue and left upper quadrant fullness
  • PMH: cervical lymphadenopathy, ~2.5 cm; spleen, palpable ~6 cm below left costal margin
  • PE: vital signs WNL, right cervical lymphadenopathy, spleen palpable 5 cm below costal margin, otherwise well-appearing
  • Laboratory findings:
    • WBC, 160,000; 68% lymphocytes (ALC, 112,000 cells/mL)
    • Hb; 9.4 g/dL
    • Platelets; 130 X 109/L
    • ANC; 174/mm3
  • Flow cytometry; CD5+, CD19+, CD23+
  • Cytogenetics, IgVH unmutated; del 17p
  •  β2M, 4.0 mg/L
  • BM biopsy; diffuse infiltration by CLL
  • Diagnosis; chronic lymphocytic leukemia
  • The patient was treated with fludarabine, cyclophosphamide, and rituximab and achieved a complete remission

Three years later, on routine follow up

  • Laboratory findings:
    • WBC; 93,000; 97% lymphocytes
    • Hb; 10.4 g/dL
    • Platelets; 123 X 109/L
    • ANC; 1,600/mm3 (WNL)
    • LDH; 242 U/L
    • Beta-2-microglobulin; 9.1 µg/L
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