A 70-Year-Old Woman with Newly Diagnosed Chronic Lymphocytic Leukemia - Episode 6

Strategies for Managing Adverse Events when Treating Chronic Lymphocytic Leukemia

Dr John Allan discusses the adverse events he monitors for with select treatments for chronic lymphocytic leukemia, and when he decides to move to second-line therapy.

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.