Devita, Hellman, and Rosenberg's Cancer

LWBK1006-32 LWW-Govindan-Review November 24, 2011 11:28

Chapter 32•Chronic Leukemias 451

Question 32.8. A 71-year-old white woman presents with awhite blood cellof 39×

109 /L, with 78% mature lymphocytes. Flow cytometry is remarkable

for the cells being CD5+, CD19+, CD23+, CD10–. The patient has

palpable lymphadenopathy in the cervical region, axillary region, and

bilateral groins, with no splenomegaly. Her hemoglobin is 13.9 g/dL, and

her platelet count is 315×109/L. Which of the following is the MOST

appropriate therapy at this time?

A. Observation with monitoring of complete blood count and physical

examination every 3 to 6 months

B. Initiation of single-agent chlorambucil

C. Initiation of single-agent fludarabine

D. Initiation of combination fludarabine, cyclophosphamide, and ritux-

imab

Question 32.9. A 54-year-old man with Rai stage 0 CLL has been followed by you for

2 years. He presents for a routine visit. His physical examination reveals

no new lymphadenopathy or splenomegaly. Which of the following find-

ings would be an indication for initiation of systemic therapy?

A. Recent hospitalization for pneumococcal pneumonia and diagnosis

of hypogammaglobulinemia

B. An increase in his absolute lymphocyte count from 15× 109 /L to

33 × 109 /L over the last 2 years

C. An increase in his absolute lymphocyte count from 24× 109 /L to

38 × 109 /L in the previous 2 months

D. Fever of 38◦C for the last 1 week without evidence of infection

Question 32.10. Which of the following is NOT true?

A. In trials comparing fludarabine versus fludarabine with rituximab,

grade 3/4 neutropenia was more common with the combination

therapy.

B. In patients with previously untreated CLL, complete remission (CR)

rates approaching 70% have been seen with combination fludarabine,

cyclophosphamide, and rituximab.

C. Combination therapy with fludarabine plus cyclophosphamide has

demonstrated superior overall survival compared with fludarabine

alone.

D. Patients with 17q and 11q deletions have demonstrated inferior

progression-free survival rates when treated with combination reg-

imens including fludarabine and cyclophosphamide.