CLL2

Question 1

How to make diagnosis of CLL?

Answer 1

Lymphocytosis >5k
BM >30% lymphocytes
<55% atypical/immature lymphoid cells in PB

Question 2

Immunophenotype of CLL

Answer 2

CD19+, CD20+ (dim), CD23+, CD5+
sIg weak (low density of surface Ig)

Question 3

Immune complications of CLL (3)

Answer 3

AIHA
PRCA
ITP

Question 4

What is Rai 0 CLL?

Answer 4

Lymphocytosis only

Question 5

What is Rai I CLL?

Answer 5

Lymphocytosis with LAD

Question 6

What is Rai II CLL?

Answer 6

Lymphocytosis with splenomegaly +/- hepatomegaly

Question 7

What is Rai III CLL?

Answer 7

Lymphocytosis with anemia
(can also have LAD and splenomegaly)

Question 8

What is Rai IV CLL?

Answer 8

Lymphocytosis and Thrombocytopenia

Question 9

What is the difference in prognosis between CLL with IGHV mutation vs unmutated?

Answer 9

Mutated has a much better prognosis

Question 10

How does CD38 factor in prognostication in CLL?

Answer 10

CD39 <30% is much better prognosis

Question 11

13q deletion as the sole abnormality has what prognosis in CLL?

Answer 11

Favorable prognosis

Question 12

CD38+ has what prognosis in CLL?

Answer 12

Bad prognosis

Question 13

ZAP70+ has what prognosis in CLL?

Answer 13

Bad

Question 14

11q- has what prognosis in CLL?

Answer 14

Bad

Question 15

IGVH unmutated status has what prognosis in CLL?

Answer 15

Bad prognosis

Question 16

IGVH mutated has what prognosis in CLL?

Answer 16

Good prognosis

Question 17

Elevated beta-2-microglobulin has what prognosis in CLL?

Answer 17

Bad

Question 18

Indications for treatment of CLL (5)

Answer 18

Constitutional symptoms
Progressive marrow failure
Recurrent AIHA or ITP
Symptomatic LAD or splenomegaly
Doubling ALC over 6 months

Question 19

Patient with symptomatic CLL with WBC 200k is started on ibrutinib. WBC checked 2 months later and is 450k now. What to do?

Answer 19

Nothing. It’s a flare related to BTK inhibitor

Question 20

Which BTK inhibitor has fewest atrial fibrillation/flutter events?

Answer 20

Zanubrutinib

Question 21

BTK inhibtiors approved for front line treatment of CLL (3)

Answer 21

Ibrutinib (not preferred)
Acalabrutinib (+/- Obin)
Zanubrutinib

Question 22

What is the difference in side effect profile between ibrutinib and acalabrutinib? (4)

Answer 22

Less HTN, Afib, minor bleeding, and ILD in acalabrutinib

Question 23

How does side effect profile between zanubritinib and ibrutinib differ?

Answer 23

Zanu: less AFib
Same HTN

Question 24

How is the dosing of venetoclax unique for first line CLL?

Answer 24

Dose escalation is needed to minimize TLS

Question 25

Mechanism of action of Idelalisib?

Answer 25

PI3K delta inhibitor

Question 26

Indication for Idelalisib and Rituximab

Answer 26

R/R CLL

Question 27

Who benefits most from FCR chemotherapy?

Answer 27

IGHV mutated

Question 28

Preferred first line therapy for CLL patients who do not want forever treatment?

Answer 28

Obinutuzumab + Venetoclax x6 cycles

Question 29

Treatment options for R/R CLL after BTKi?

Answer 29

Idelalisib + Ritux Duvelisib Venetoclax + Ritux CAR-T (Lisocabtagene maraleucel) Pirtobrutinib Ibrutinib + Venetoclax Lenalidomide +/- Ritux

Question 30

Preferred front line treatment for CLL with 17p deletion?

Answer 30

BTKi or Obin/Ven

Question 31

Immunophenotype of hairy cell leukemia

Answer 31

CD19+, CD20+, CD103+, CD11c+, CD25+, CD123+

Question 32

Immunophenotype: CD19+, CD20+, CD103+, CD11c+, CD25+, CD123+. TRAP+. Diagnosis?

Answer 32

Hairy cell leukemia

Question 33

First line treatment for hairy cell leukemia? (2)

Answer 33

Cladribine +/- Rituximab or Pentostatin

Question 34

What driver mutation is commonly seen in hairy cell leukemia?

Answer 34

BRAF V600E

Question 35

Preferred treatment of R/R hairy cell leukemia?

Answer 35

Vemurafenib +/- Ritux Dabrafenib + Trametinib

Question 36

What autoimmune condition is frequently seen with T-LGL?

Answer 36

RA

Question 37

Treatment for T-LGL?

Answer 37

Cyclophosphamide, MTX, or cyclosporine

Question 38

In patients with CLL and AIHA who need treatment, what treatment regimen should you avoid?

Answer 38

FCR Fludarabine can cause AIHA

Question 39

Treatment options (2) for B-PLL?

Answer 39

BTKi Ven + Obin