Considering Comorbidities when Choosing a Chronic Lymphocytic Leukemia Treatment
John Allan, MD, explains how fitness level and comorbidities affect his treatment selections for chronic lymphocytic leukemia and whether he prefers fixed-duration or continuous-strategy approaches.
Case: A 70-Year-Old Woman with Newly Diagnosed Chronic Lymphocytic Leukemia
Initial Presentation:
- A 70-year-old woman presented to her PCP for a routine checkup complaining of moderate, progressive fatigue and unintended weight loss over the last 4 months.
- PMH: hypercholesterolemia (well controlled on medication; reports having a relatively healthy diet)
- SH: Retired nurse; exercises at least 30 minutes per day most days of the week; enjoys spending time with her grandkids and traveling with her spouse; ~1-2 drinks in social settings per week
- PE: vital signs WNL, right cervical lymphadenopathy~2.7 cm, spleen palpable 5 cm below costal margin, otherwise well-appearing
- Laboratory findings:
- WBC 186,000; 75% lymphocytes
- Hb 9.4 g/dL
- Platelets 85 X 109/L
- Cr Cl: 61 ml/min
- Flow cytometry; CD5+, CD19+, CD23+
- beta2M, 3.8 mg/L
- IGHV mutational status: unmutated; TP53 unmutated
- ECOG PS 0
- BM biopsy; diffuse infiltration by CLL
Treatment:
- Options for treatment were reviewed and discussed with the patient, her spouse, and the care team.
- The decision was made to initiate the patient on fixed duration venetoclax + obinutuzumab.
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