Frontline Treatment Approaches in Patients with Chronic Lymphocytic Leukemia


Dr John Allan gives an overview of the frontline treatment options available for chronic lymphocytic leukemia with reference to clinical trial data.

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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