A 72-year-old woman with CLL (Binet stage C) requires treatment. She has del(17p) detected by FISH. Her renal function is reduced (CrCl 38 mL/min). The preferred treatment based on current guidelines (NCCN/ESMO) is:
- A Ibrutinib (BTK inhibitor) monotherapy ✓
- B Fludarabine-cyclophosphamide-rituximab (FCR)
- C Chlorambucil plus obinutuzumab
- D Venetoclax plus rituximab
Correct answer: A. Ibrutinib (BTK inhibitor) monotherapy
Explanation
Del(17p) (TP53 deletion/mutation) is the highest-risk molecular marker in CLL, conferring resistance to standard chemoimmunotherapy (FCR, bendamustine-rituximab). BTK inhibitors (ibrutinib, acalabrutinib) are the preferred treatment for del(17p) CLL regardless of fitness, as demonstrated in the RESONATE and ELEVATE trials. Reduced renal function further contraindicates FCR. Venetoclax-obinutuzumab is an alternative for del(17p) per CLL14 trial data, particularly for unfit patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.