A 70-year-old man is incidentally found to have a lymphocyte count of 22,000/µL. Peripheral smear shows smudge cells. Flow cytometry shows CD5+, CD19+, CD23+, CD20 (dim), surface IgM (dim). Bone marrow biopsy shows 40% infiltration. He is asymptomatic with no lymphadenopathy or organomegaly and haemoglobin 13.2 g/dL. According to Rai staging and current CLL guidelines, what is the appropriate management?

• A Start chemoimmunotherapy (FCR) immediately to prevent disease progression
• B Ibrutinib to be started immediately in all newly diagnosed CLL
• C Allogeneic stem cell transplantation as early consolidation
• D Active surveillance ('watch and wait'); treatment initiated only when Rai stage III/IV or specific iwCLL treatment criteria are met ✓

Explanation

This is Rai stage 0 or I CLL (lymphocytosis with no anaemia or thrombocytopenia). International Workshop on CLL (iwCLL) guidelines recommend active surveillance for asymptomatic early-stage CLL. Treatment is started only when Rai stage III/IV disease develops or when iwCLL criteria are met (e.g., doubling time < 6 months, bulky disease, B symptoms, progressive cytopenias). Early treatment has not been shown to improve overall survival.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.