CLL/SLL Part II

Question 1

When should we use prophylactic IVIG in CLL patients?

Answer 1

The use of prophylactic IVIG in CLL patients to restore IgG levels is controversial.

IVIG is used in general for those with:
- recurrent infections and whose serum IgG <500 mg/dL

Question 2

What is Idelalisib?

Answer 2

Phosphoinositide 3-kinase (PI3K) delta inhibitor

Question 3

What has Idelalisib been associated with?

Answer 3

Serious, potentially fatal diarrhea and/or colitis
Fatal and/or serious hepato-toxicity
Fatal and/or serious pneumonitis

Question 4

Anemia in CLL - What are the possible reasons?

Answer 4

1) GI Blood loss
- steroids, thrombocytopenia, mucositis, coagulopathy
2) Marrow infiltration with disease
3) Myelosuppression due to treatment
4) Hemolytic anemia
5) Hypersplenism
6) Red cell aplasia

Question 5

What is Evan’s syndrome

Answer 5

Immune thrombocytopenia + Concurrent autoimmune hemolytic anemia

Up to 1/3 of CLL patients will have Evan’s syndrome

Question 6

What sort of vaccinations is required s/p splenectomy and when?

Answer 6

2-3 weeks prior to splenectomy

Pneumococcus,
H.influenzae B
Meningococcus

Inactivated vaccines.

Question 7

What is Richter’s transformation, and how often does it occur?

Answer 7

Richter’s transformation = transformation of CLL into an aggressive large-cell lymphoma.

5-10% of CLL patients will have Richter’s transformation or prolymphocytic leukemia

Question 8

Who should not be considered for Fludarabine-based therapy?

Answer 8

Del (17p) mutation
TP53 mutation

Re-consider if pt > 70 yo

Question 9

What is Venetoclax?

Answer 9

BCL2 inhibitor

An alternative for those with 17p deletion, especially for those who relapsed after Ibrutinib