CLL facts

Question 1

Unmutated IGHV in CLL %

Answer 1

50%

Question 2

Immunophenotype CLL

Answer 2

CD5, CD23, CD19 positive
Dim immunoglobulin, CD20, CD22, CD79b

Question 3

B sym in CLL presentation

Answer 3

5-10%

Question 4

MBL to CLL

Answer 4

1-2% a year

Question 5

Cytogenetic aberrations in CLL

Answer 5

del13q, tri 12, del11, del17p

Question 6

del17p % in CLL

Answer 6

10%

Question 7

Rai

Answer 7

0- lymphocytosis
I- lymphadenopathy
II - Hepato-splenomegaly
III- Anemia (Hb < 11)
IV- Thrombocytopenia (PLT< 100)

Question 8

Binet

Answer 8

A < 3 lymph node areas
B >= 3 lymph nodes
C -Anemia/Thrormbocytopenia (10/100)

Question 9

CLL-IPI

Answer 9

17p- 4 points
IGHV- Unmutated- 2 points
B2mg- >3.5 2point
Rai > 0 - 1 point
Age > 65 1 point

Question 10

% never needing Tx in CLL

Answer 10

30%

Question 11

IVIG Tx in CLL

Answer 11

Ig < 500
and recurrent infections
given once every 6-8 weeks

Question 12

Tx for ASx pts in CLL

Answer 12

Ibrutinib improved EFS but not OS (87% vs 60%)
Hence not clearly beneficial

Question 13

Reasons for disease progression on BTKi in CLL

Answer 13

Mutation in BTK binding site (66-80%)

Question 14

Zanu 1st line CLL

Answer 14

SEQUOIA trial
vs BR
24 month PFS 85% no OS
p53 also good response

Question 15

Perioperative instructions for BTKi

Answer 15

Discontinue 3-7 days pre surgery
Resume 3-7 days post surgery

Question 16

Ibrutinib 1st line Tx in CLL

Answer 16

RESONATE-2 (age >65)
iLLUMINATE (age> 65 or comorbities, including 17p)
ECOG1912 (age<70)
All comparing to chemo
No advantage to R addition
60-80% PFS
OS benefit

Question 17

Acala 1st line in CLL

Answer 17

ELEVATE-TN
compared to chemo
5 year PFS 70% compared to 20%
adding Obinutuzumab improved PFS to 80% and improves OS!!
Cost of SE

Question 18

Ven 1st line in CLL

Answer 18

CLL14
60% 6 year PFS
but only 20% in p53
Improves OS

GLOW - V+I for 15 months (3 months I lead in + 12m V+I)
MDACC for 2 years

Question 19

Ven+ Ibrutinib 1st line in CLL

Answer 19

GLOW
3 months of Ibrutinib followed by 12 months of VI
PFS 84%
compared to chloranbucil + O

MDACC
phase II
24 months for all
another 12 months is MR+
95% 5 year PFS
benefit also for p53

Flayer
MRD guided
Double the time to MRD

Question 20

2nd line Tx in CLL

Answer 20

Ibrutinib- RESONATE
Acala- ASCEND, ELEVATE-RR
Zanu- ALPINE
vs Ibrutinib
PFS
MURANO
REVENG

Question 21

Richter %

Answer 21

10%

Question 22

Richter type %

Answer 22

90% DLBCL
10% HL

Question 23

Richter OS

Answer 23

DLBCL- median 3-4 mon
HL- 70% 2 year OS

Question 24

Pirtobrutinib in RR CLL

Answer 24

BRUIN
Phase II
Most were double class refractory
80% ORR most PR
PFS of 2 years

Question 25

Common mutation of BTK causing resistance to BTKi in CLL

Answer 25

C481S Prirtobrutinib still efective

Question 26

CAR-T in CLL

Answer 26

Liso-cell Not as effective as in DLBCL

Question 27

Favorable risk FISH in CLL

Answer 27

del13q

Question 28

CD38 and ZAP70 in CLL

Answer 28

correlate with unmutated disease

Question 29

Most common mutation causing resistance to covalent BTKi

Answer 29

C481S

Question 30

Pirtobrutunib SE

Answer 30

Neutropenia

Question 31

IGHV mutation cutoff in CLL

Answer 31

2%

Question 32

IGHV mutation in CLL that has poor prognosis

Answer 32

IGHV3-21

Question 33

Administration of BTKi

Answer 33

Before bed After meal Avoid grapefruit

Question 34

Acala vs Chlorambucil in ND CLL

Answer 34

Compared to chlorambucil obino Acala with PFS not OS Adding obinotuzumab improves OS

Question 35

Acala vs Ibruitib in RR CLL

Answer 35

Non inferior Less toxicity

Question 36

Zanu vs Ibruitib in RR CLL

Answer 36

Better PFS Less AF Same HTN More neutropenia But not FN

Question 37

Trisomy 12 in CLL

Answer 37

Intermediate prognosis Worse if NOTCH1 present Can present with strong CD20 and CD79a