A 66-year-old man with CLL (Rai Stage III) has del(17p) detected on FISH. He requires treatment. Which statement BEST describes the impact of del(17p) on therapy selection?
- A It predicts resistance to fludarabine-based chemotherapy and BTK inhibitors are preferred ✓
- B It is a favourable prognostic marker requiring only watch-and-wait
- C Rituximab monotherapy is the treatment of choice
- D Allogeneic SCT is the only curative option regardless of BTK inhibitor response
Correct answer: A. It predicts resistance to fludarabine-based chemotherapy and BTK inhibitors are preferred
Explanation
del(17p) results in loss of TP53, the key DNA damage response gene; it predicts primary resistance to fludarabine-based chemoimmunotherapy (FCR, BR) and is associated with very poor outcomes with conventional chemotherapy. Current international guidelines (iwCLL, NCCN, EHA-ESMO) recommend ibrutinib or acalabrutinib (BTK inhibitors) or venetoclax-based regimens as first-line treatment in del(17p)/TP53 mutant CLL.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.