CLL

Question 1

CLL Immunophenotype

Answer 1

CD5(+) + CD10-, CD19+, CD20 (dim), CD23(+) surface Ig (dim, bright expresses leukemic phase of another b cell neoplasm)

Question 2

Mantle cell immunophenotype

Answer 2

CD5+ (like CLL, but CD23 negative)

Question 3

Low risk cytogenetic features of CLL

Answer 3

1) Del 13q14
2) Trisomy 12 + del 11s22.3 (ATM)

Question 4

sequela of CLL

Answer 4

*Pure red cell aplasia
*secondary malignancies (eg nonmelanoma skin cancers)

Question 5

Indications for treatment in CLL

Answer 5

Evidence of progressive marrow failure (Hgb <10, plt count <100k and declining, and neutropenia) (IF stable cytopenia (eg. plt <100), doesn’t need treatment)
Massive (ie, ≥6 cm below the left costal margin) OR symptomatic splenomegaly (>6cm)
Massive (ie, ≥10 cm in longest diameter) OR symptomatic lymphadenopathy
Progressive lymphocytosis with an increase of >50 percent over a two-month period OR lymphocyte doubling time (LDT) of <6 months (**relative indication)
**IF absolute count <30k, observe for longer period of time before starting treatment even if LDT <6 months
*Lymphocytosis alone is not a strict indication for treatment…
*exclude infection first (can have exaggerated lymphocyte response to infection)
Constitutional symptoms (Significant fatigue (ie, ECOG PS >2, inability to perform usual activities), Night sweats for ≥1 month without evidence of infection, Unintentional weight loss ≥10 percent within the previous six months, Fevers for ≥2 weeks without other evidence of infection – impacting quality of life
Treatment (eg. steroid) refractory autoimmune cytopenias,

Question 6

1) PI3k inhibitor SE’s 2) Required prophylaxis when using

Answer 6

1) pneumonitis, diarrhea, PNA
2) PJP ppx

Question 7

Immunophenotypic marker that is adverse prognosticator in CLL

Answer 7

CD38+

Question 8

ibrutinib most common SE

Answer 8

Hypertension

Question 9

BTK inhibitor less likely to cause AF

Answer 9

Zanubrutinib

Question 10

PI3k SE’s

Answer 10

Itis’s (colitis, transaminitis, pneumonitis)

Question 11

Other commonly tested cause of anemia in CLL

Answer 11

PRCA

Question 12

PRCA clinical features

Answer 12

isolated anemia w/ reticulocytopenia

Question 13

CD20 expression in CLL

Answer 13

*Dim