Chronic Lymphocytic Leukemia

Question 1

True or false. CLL is primarily a disease of older adults, with a median age at diagnosis of 71.

Answer 1

True

Question 2

True or false. CLL is one of the only types of leukemias NOT linked to radiation exposure. CLL is one of the most FAMILIAL-ASSOCIATED malignancies, and the first-degree relative of CLL patient has an 8.5 fold elevated risk of developing CLL.

Answer 2

True

Question 3

True or false. The presentation of CLL most commonly occurs as an incidental diagnosiswith an elevated lymphocyte count in an asymptomatic individual.

Answer 3

True

Question 4

It is a disorder wherein patients do not meet the diagnostic criteria for CLl based on quantification of clonal B cells in the peripheral blood and who do not have associated signs of CLL, including lymphadenopathy, organomegaly, or cytopenias.

Answer 4

Monoclonal B-cell Lymphocytosis

Question 5

The most common secondary malignancies seen as complication of CLL are __.

Answer 5

Skin cancer, prostate, and breast cancers

Question 6

In CLL, treatment for ITP is usually instituted when platelet levels drop to ___ or if ther is evidence of bleeding complications or need for invasive procedures.

Answer 6

20,000-30,000

Question 7

It is the transformation of CLL to an aggressive lymphoma, most commonly DLBCL.

Answer 7

Richter’s Transformation

Question 8

True of Richter’s Transformation.
A. Rapid progression in adenopathy, often in a specific are
B. Constitutional symptoms
C. LDH is usually high
D. In suspected cases, first step is FDG-PET/CT scan to localize an area for biopsy.

Answer 8

All are true

Question 9

True of FDG PET/CT scan result in suspected Richter’s Transformation cases.
A. Standardized uptake values (SUV) <5 is consistent with CLL and can rule out Richter’s Transformation in many cases.
B. SUV >5 are suspicious for Richter’s Transformation
C. SUV >=10 is very concerning

Answer 9

All are true

Question 10

True or false. In Richter’s Transformation, excisional biopsy is diagnostic aeedle biopsy should be DISCOURAGED.

Answer 10

True

Question 11

These are the twi widely used staging systems in CLL, which rely on PE and lab studies, and do not require imaging or bone marrow analysis.

Answer 11

Rai and Binet Staging systems.

See Table 103-3, page 767 of Harrisons please 😄

Question 12

True or false. A watchful waiting strategy is used for most patients with CLL, with therapy reserved for patients with symptomatic disease, since trials showed no survival advantage with earlier therapy.

Answer 12

True

Question 13

Which of the following are included in the criteria for the initiation of therapy in CLL?
A. Evidence of progressive marrow failure (worsening of anemia or thrombocytopenia not due to autoimmune destruction)
B. Massive (>=6cm below costal margin), progressive, or symptomatic splenomegaly
C. Massive (>=10cm), progressive, or symptomatic lymphadenopathy
D. Autoimmune anemia or thrombocytopenia not responsive to standard therapy
E. Consitutional symptoms (1 or more of the ff: unintentional weight loss >=10% over 6 months, significant fatigue, feveres >100.5C for >2 weeks without infection, night sweats for >1 month without infection)

Answer 13

All are included 😄

Question 14

These consists the gold standard for therapy of CLL for patients who are young <65 years old.

Answer 14

Fludarabine, cyclophosphamide, rituximab

Question 15

This is a reversible, p110 delta idoform-specific PI3K inhibitor.

Answer 15

Idelalisib

Question 16

This is a relatively selective,mirreversible inhibitor of BTK.

Answer 16

Ibrutinib

Question 17

What is true of complete response?
A. Lymphocyte count <4000/ul
B. No lymph nodes > 1.5cm
C. Nonpalpable liver/spleen
D. Bone marrow: normocellular, <30% lymphocytes, no B lymphoid nodules
E. Peripheral blood: plt >100,000/ul, Hgb >11g/dL, Neutrophils >1500/ul

Answer 17

All are true.

See table 103-5, page 769 for other response criteria in CLL 😄

Question 18

True or false. CLL is treated only when it becomes symptomatic.

Answer 18

True.