A 65-year-old man is found incidentally to have lymphocytosis of 28,000/μL. Peripheral smear shows mature small lymphocytes and smudge cells. Flow cytometry reveals CD5+, CD19+, CD23+, surface Ig (dim), CD10−. He is asymptomatic with no lymphadenopathy or splenomegaly. What is the most appropriate management?
- A Immediately initiate FCR (fludarabine, cyclophosphamide, rituximab) chemotherapy
- B Watch-and-wait with periodic monitoring ✓
- C Allogeneic stem cell transplantation
- D Ibrutinib treatment
Correct answer: B. Watch-and-wait with periodic monitoring
Explanation
This is chronic lymphocytic leukemia (CLL) confirmed by the characteristic immunophenotype (CD5+, CD19+, CD23+, dim sIg). Early-stage asymptomatic CLL (Rai stage 0–II without B symptoms, massive organomegaly, or cytopenias) does not benefit from early treatment, and the standard of care is watch-and-wait. Multiple randomized trials have confirmed that early treatment does not improve survival in asymptomatic early-stage CLL, while delaying therapy avoids treatment toxicity.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.