A 72-year-old woman is found to have absolute lymphocytosis of 28,000/µL on a routine CBC. She is asymptomatic with no lymphadenopathy or splenomegaly. Flow cytometry shows CD5+/CD19+/CD23+/CD20(dim) B-cells with kappa light chain restriction. Fluorescence in situ hybridization (FISH) shows del(13q14) as the sole abnormality. Rai stage is 0. Management is:
- A Initiate chemoimmunotherapy (FCR: fludarabine, cyclophosphamide, rituximab)
- B Watch and wait (active surveillance) ✓
- C Ibrutinib (BTK inhibitor) monotherapy
- D Allogeneic stem cell transplantation
Correct answer: B. Watch and wait (active surveillance)
Explanation
Chronic lymphocytic leukemia (CLL) at Rai stage 0 (lymphocytosis only, no anemia, thrombocytopenia, or lymphadenopathy) with del(13q14) — the most favorable cytogenetic abnormality — requires no treatment. The CLL8 and GCLLSG trials confirmed that early treatment of asymptomatic low-stage CLL does not improve overall survival. Treatment is initiated when Rai stage III/IV develops, or active disease criteria appear (progressive lymphocytosis doubling <6 months, B symptoms, symptomatic lymphadenopathy/splenomegaly, autoimmune cytopenias).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.