Considering Comorbidities when Choosing a Chronic Lymphocytic Leukemia Treatment


John Allan, MD, explains how fitness level and comorbidities affect his treatment selections for chronic lymphocytic leukemia and whether he prefers fixed-duration or continuous-strategy approaches.

Case: A 70-Year-Old Woman with Newly Diagnosed Chronic Lymphocytic Leukemia

Initial Presentation:

  • A 70-year-old woman presented to her PCP for a routine checkup complaining of moderate, progressive fatigue and unintended weight loss over the last 4 months.
  • PMH: hypercholesterolemia (well controlled on medication; reports having a relatively healthy diet)
  • SH: Retired nurse; exercises at least 30 minutes per day most days of the week; enjoys spending time with her grandkids and traveling with her spouse; ~1-2 drinks in social settings per week
  • PE: vital signs WNL, right cervical lymphadenopathy~2.7 cm, spleen palpable 5 cm below costal margin, otherwise well-appearing
  • Laboratory findings:
    • WBC 186,000; 75% lymphocytes
    • Hb 9.4 g/dL
    • Platelets 85 X 109/L
  • Cr Cl: 61 ml/min
  • Flow cytometry; CD5+, CD19+, CD23+
  • beta2M, 3.8 mg/L
  • IGHV mutational status: unmutated; TP53 unmutated
  • ECOG PS 0
  • BM biopsy; diffuse infiltration by CLL


  • Options for treatment were reviewed and discussed with the patient, her spouse, and the care team.
  • The decision was made to initiate the patient on fixed duration venetoclax + obinutuzumab.
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