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Malignant Hematology > CLL > Flashcards

CLL Flashcards

1
Q

How to make diagnosis of CLL?

A

Lymphocytosis >5k
BM >30% lymphocytes
<55% atypical/immature lymphoid cells in PB

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2
Q

Immunophenotype of CLL

A

CD19+, CD20+ (dim), CD23+, CD5+
sIg weak (low density of surface Ig)

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3
Q

Immune complications of CLL (3)

A

AIHA
PRCA
ITP

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4
Q

What is Rai 0 CLL?

A

Lymphocytosis only

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5
Q

What is Rai I CLL?

A

Lymphocytosis with LAD

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6
Q

What is Rai II CLL?

A

Lymphocytosis with splenomegaly +/- hepatomegaly

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7
Q

What is Rai III CLL?

A

Lymphocytosis with anemia
(can also have LAD and splenomegaly)

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8
Q

What is Rai IV CLL?

A

Lymphocytosis and Thrombocytopenia

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9
Q

What is the difference in prognosis between CLL with IGHV mutation vs unmutated?

A

Mutated has a much better prognosis

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10
Q

How does CD38 factor in prognostication in CLL?

A

CD39 <30% is much better prognosis

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11
Q

13q deletion as the sole abnormality has what prognosis in CLL?

A

Favorable prognosis

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12
Q

CD38+ has what prognosis in CLL?

A

Bad prognosis

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13
Q

ZAP70+ has what prognosis in CLL?

A

Bad

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14
Q

11q- has what prognosis in CLL?

A

Bad

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15
Q

IGVH unmutated status has what prognosis in CLL?

A

Bad prognosis

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16
Q

IGVH mutated has what prognosis in CLL?

A

Good prognosis

17
Q

Elevated beta-2-microglobulin has what prognosis in CLL?

A

Bad

18
Q

Indications for treatment of CLL (5)

A

Constitutional symptoms
Progressive marrow failure
Recurrent AIHA or ITP
Symptomatic LAD or splenomegaly
Doubling ALC over 6 months

19
Q

Patient with symptomatic CLL with WBC 200k is started on ibrutinib. WBC checked 2 months later and is 450k now. What to do?

A

Nothing. It’s a flare related to BTK inhibitor

20
Q

Which BTK inhibitor has fewest atrial fibrillation/flutter events?

A

Zanubrutinib

21
Q

BTK inhibtiors approved for front line treatment of CLL (3)

A

Ibrutinib (not preferred)
Acalabrutinib (+/- Obin)
Zanubrutinib

22
Q

What is the difference in side effect profile between ibrutinib and acalabrutinib? (4)

A

Less HTN, Afib, minor bleeding, and ILD in acalabrutinib

23
Q

How does side effect profile between zanubritinib and ibrutinib differ?

A

Zanu: less AFib
Same HTN

24
Q

How is the dosing of venetoclax unique for first line CLL?

A

Dose escalation is needed to minimize TLS

25
Q

Mechanism of action of Idelalisib?

A

PI3K delta inhibitor

26
Q

Indication for Idelalisib and Rituximab

A

R/R CLL

26
Q

Who benefits most from FCR chemotherapy?

A

IGHV mutated

27
Q

Preferred first line therapy for CLL patients who do not want forever treatment?

A

Obinutuzumab + Venetoclax x6 cycles

28
Q

Treatment options for R/R CLL after BTKi?

A

Idelalisib + Ritux
Duvelisib
Venetoclax + Ritux
CAR-T (Lisocabtagene maraleucel)
Pirtobrutinib
Ibrutinib + Venetoclax
Lenalidomide +/- Ritux

29
Q

Preferred front line treatment for CLL with 17p deletion?

A

BTKi or Obin/Ven

30
Q

Immunophenotype of hairy cell leukemia

A

CD19+, CD20+, CD103+, CD11c+, CD25+, CD123+

31
Q

Immunophenotype: CD19+, CD20+, CD103+, CD11c+, CD25+, CD123+. TRAP+. Diagnosis?

A

Hairy cell leukemia

32
Q

First line treatment for hairy cell leukemia? (2)

A

Cladribine +/- Rituximab or
Pentostatin

33
Q

What driver mutation is commonly seen in hairy cell leukemia?

A

BRAF V600E

34
Q

Preferred treatment of R/R hairy cell leukemia?

A

Vemurafenib +/- Ritux
Dabrafenib + Trametinib

35
Q

What autoimmune condition is frequently seen with T-LGL?

A

RA

36
Q

Treatment for T-LGL?

A

Cyclophosphamide, MTX, or cyclosporine

37
Q

In patients with CLL and AIHA who need treatment, what treatment regimen should you avoid?

A

FCR
Fludarabine can cause AIHA

38
Q

Treatment options (2) for B-PLL?

A

BTKi
Ven + Obin

Malignant Hematology (13 decks)

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