![]() BTK inhibitors (e.g., ibrutinib, acalabrutinib).In most patients with CLL, a BTK inhibitor or BCL-2 inhibitor is the first-line treatment.The pretreatment evaluation is used to determine which regimen is used.Further testing (e.g., CT scan, bone marrow biopsy): may be necessary for patients enrolling in clinical trials.Further imaging is not routinely required for diagnosis unless clinically indicated.Chest x-ray: to evaluate for mediastinal lymphadenopathy.Infectious disease serology: for HBV, HCV, HIV, and CMV.Immunoglobulin levels: to evaluate for hypogammaglobulinemia. ![]() Repeat cytogenetic testing see “ Prognostic markers in CLL.”.CMP: to document baseline organ function.Clinical assessment: physical examination, and functional status assessment (e.g., ECOG score).Treatment of low-risk disease is usually not recommended and is unlikely to extend survival. Allogeneic HSCT: currently the only curative treatment option (not routinely performed)ĬLL is a malignancy with a slow rate of cell division and disease progression.Chemoimmunotherapy, e.g., FCR: fludarabine, cyclophosphamide, rituximab.Targeted therapy, e.g., ibrutinib, rituximab, alemtuzumab.High-risk disease ( Rai stage III or IV): medical therapy.Medical therapy: indicated for progressive or symptomatic disease (i.e., active disease ).Consider expectant management if stable and asymptomatic.Intermediate risk disease ( Rai stage I or II).Regular follow-ups to assess for disease progression and indications for treatment.Indications for anticancer therapy : based on disease risk ( Rai staging) and disease activity.Lymph node biopsy: Consider if the diagnosis is uncertain or for the diagnosis of SLL or Richter transformation.Typical findings in aspirate include a high percentage of small mature lymphocytes. ![]()
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