Ongoing Challenges in the Treatment of Frontline Chronic Lymphocytic Leukemia

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

Treatment:

• 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.