A 70-year-old man has chronic lymphocytic leukemia. Genomic testing shows del(11q22.3) affecting ATM gene. Compared to del(13q14) as a sole abnormality, del(11q) confers:
- A Favorable prognosis; median OS >15 years
- B Worst prognosis of all CLL cytogenetics, worse than del(17p)
- C Intermediate prognosis with bulky lymphadenopathy and shorter lymphocyte doubling time ✓
- D Excellent response to fludarabine monotherapy making it favorable
Correct answer: C. Intermediate prognosis with bulky lymphadenopathy and shorter lymphocyte doubling time
Explanation
In the Döhner hierarchical cytogenetic classification of CLL, del(11q) confers intermediate-unfavorable prognosis with median OS ~79 months; it is associated with bulky lymphadenopathy, rapid progression, and shorter time to first treatment, but is NOT the worst prognosis — del(17p) (TP53 deletion) carries the worst outcome (~32 months median OS) and resistance to chemoimmunotherapy. Del(13q14) as a sole lesion is the most favorable. Del(11q) patients benefit from alkylating agents and Bruton tyrosine kinase inhibitors.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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