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

Video

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
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1 expert in this video
1 expert in this video
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
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