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|Videos|June 8, 2020
A 73-Year-Old Man With Relapsed Chronic Lymphocytic Leukemia
Author(s)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.
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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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