A 70-year-old man with CLL has del(17p) on FISH and TP53 mutation. He requires treatment for bulky lymphadenopathy. Which treatment regimen is most appropriate given the high-risk cytogenetics?

• A FCR (fludarabine, cyclophosphamide, rituximab)
• B Chlorambucil and obinutuzumab
• C Ibrutinib or venetoclax-based regimen ✓
• D Bendamustine and rituximab

Explanation

Del(17p)/TP53-mutated CLL is resistant to chemotherapy including FCR and bendamustine-rituximab due to impaired p53-mediated apoptosis. Targeted therapy with BTK inhibitors (ibrutinib, acalabrutinib) or venetoclax (BCL-2 inhibitor) plus obinutuzumab is the standard of care for del(17p)/TP53-mutated CLL. FCR and chlorambucil-based regimens are ineffective and potentially harmful in this setting.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.