Part 2: Chronic Lymphocytic Leukemia

Kami J. Maddocks, MD

Assistant professor of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH

Samantha M. Jaglowski, MD

Assistant professor of Internal Medicine, Division of Hematology, The Ohio State University, Columbus, OH

Question 2

A 71-year-old man presents after he was found to have a lymphocytosis on routine blood work that was done prior to a minor procedure. His WBC count is 25,000/ÁL with 81% mature lymphocytes. His hemoglobin is 13.2 g/dL and his platelet count is 220,000/ÁL. On physical exam, he has 1 x 1-cm bilateral axillary lymphadenopathy but no other abnormal findings. Flow cytometry is remarkable for a clonal population of cells that are positive for CD5, CD19, CD23, and CD20 (dim) and negative for CD10. Which of the following is the most appropriate therapy at this time?

  •   Observation with monitoring of complete blood count every 3 months for
    the first year then every 3 to 6 months thereafter
  •   Initiation of single-agent chlorambucil
  •   Initiation of single-agent fludarabine
  •   Initiation of combination chemotherapy with fludarabine, cyclophosphamide,
    and rituximab

Updated 08/17/2012 • jdw | Copyright ©2014 Turner White Communications