A 73-Year-Old Man With Relapsed Chronic Lymphocytic Leukemia

June 8, 2020
Danielle M. Brander, MD

Danielle M. Brander, MD, remarks on the appropriateness for targeted therapy as a treatment option for a 73-year-old man with relapsed chronic lymphocytic leukemia.


Case: A 73-Year-Old Man With Relapsed Chronic Lymphocytic Leukemia

Initial Presentation

  • A 73-year-old man presented to his PCP for an annual checkup; he complained of mild intermittent fatigue and occasional night sweats
  • PMH: hypertension, medically controlled
  • PE: palpable axillary and right-sided cervical lymphadenopathy

Clinical Work-up

  • Labs: WBC 48,000, lymphocyte 72%, ANC 3700/mm3, Hb 9.4 g/dL, plt 100 x 109/L, LDH 240 U/L, Beta-2-microglobulin 4.1 mg/L
  • FC CD 5+, CD23+, CD20+ monoclonal B-cell population
  • FISH: normal for all CLL probe set tested, no evidence t11;14
  • IGHV mutational status: unmutated
  • Rai stage IV; Binet stage B
  • ECOG PS 0


Treatment and Follow-up

  • He was started on ibrutinib 420 mg PO qDay; symptoms improved and achieved stable disease resolution of lymphadenopathy
  • After about 3 years he complained of increasing fatigue and decreased appetite, on PE return of palpable lymphadenopathy spleen was palpable ~4 cm below costal margin; creatinine clearance 56 mL/min