CLL Flashcards
How to make diagnosis of CLL?
Lymphocytosis >5k
BM >30% lymphocytes
<55% atypical/immature lymphoid cells in PB
Immunophenotype of CLL
CD19+, CD20+ (dim), CD23+, CD5+
sIg weak (low density of surface Ig)
Immune complications of CLL (3)
AIHA
PRCA
ITP
What is Rai 0 CLL?
Lymphocytosis only
What is Rai I CLL?
Lymphocytosis with LAD
What is Rai II CLL?
Lymphocytosis with splenomegaly +/- hepatomegaly
What is Rai III CLL?
Lymphocytosis with anemia
(can also have LAD and splenomegaly)
What is Rai IV CLL?
Lymphocytosis and Thrombocytopenia
What is the difference in prognosis between CLL with IGHV mutation vs unmutated?
Mutated has a much better prognosis
How does CD38 factor in prognostication in CLL?
CD39 <30% is much better prognosis
13q deletion as the sole abnormality has what prognosis in CLL?
Favorable prognosis
CD38+ has what prognosis in CLL?
Bad prognosis
ZAP70+ has what prognosis in CLL?
Bad
11q- has what prognosis in CLL?
Bad
IGVH unmutated status has what prognosis in CLL?
Bad prognosis
IGVH mutated has what prognosis in CLL?
Good prognosis
Elevated beta-2-microglobulin has what prognosis in CLL?
Bad
Indications for treatment of CLL (5)
Constitutional symptoms
Progressive marrow failure
Recurrent AIHA or ITP
Symptomatic LAD or splenomegaly
Doubling ALC over 6 months
Patient with symptomatic CLL with WBC 200k is started on ibrutinib. WBC checked 2 months later and is 450k now. What to do?
Nothing. It’s a flare related to BTK inhibitor
Which BTK inhibitor has fewest atrial fibrillation/flutter events?
Zanubrutinib
BTK inhibtiors approved for front line treatment of CLL (3)
Ibrutinib (not preferred)
Acalabrutinib (+/- Obin)
Zanubrutinib
What is the difference in side effect profile between ibrutinib and acalabrutinib? (4)
Less HTN, Afib, minor bleeding, and ILD in acalabrutinib
How does side effect profile between zanubritinib and ibrutinib differ?
Zanu: less AFib
Same HTN
How is the dosing of venetoclax unique for first line CLL?
Dose escalation is needed to minimize TLS
Mechanism of action of Idelalisib?
PI3K delta inhibitor
Indication for Idelalisib and Rituximab
R/R CLL
Who benefits most from FCR chemotherapy?
IGHV mutated
Preferred first line therapy for CLL patients who do not want forever treatment?
Obinutuzumab + Venetoclax x6 cycles
Treatment options for R/R CLL after BTKi?
Idelalisib + Ritux
Duvelisib
Venetoclax + Ritux
CAR-T (Lisocabtagene maraleucel)
Pirtobrutinib
Ibrutinib + Venetoclax
Lenalidomide +/- Ritux
Preferred front line treatment for CLL with 17p deletion?
BTKi or Obin/Ven
Immunophenotype of hairy cell leukemia
CD19+, CD20+, CD103+, CD11c+, CD25+, CD123+
Immunophenotype: CD19+, CD20+, CD103+, CD11c+, CD25+, CD123+. TRAP+. Diagnosis?
Hairy cell leukemia
First line treatment for hairy cell leukemia? (2)
Cladribine +/- Rituximab or
Pentostatin
What driver mutation is commonly seen in hairy cell leukemia?
BRAF V600E
Preferred treatment of R/R hairy cell leukemia?
Vemurafenib +/- Ritux
Dabrafenib + Trametinib
What autoimmune condition is frequently seen with T-LGL?
RA
Treatment for T-LGL?
Cyclophosphamide, MTX, or cyclosporine
In patients with CLL and AIHA who need treatment, what treatment regimen should you avoid?
FCR
Fludarabine can cause AIHA
Treatment options (2) for B-PLL?
BTKi
Ven + Obin
