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CLL — RACP Adult Medicine MCQ

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EasyHaematologyCLLRACP Adult Medicine

A 65-year-old man presents with lymphocytosis (WCC 45 × 10⁹/L, lymphocytes 40 × 10⁹/L). Blood film shows mature small lymphocytes with smear cells. Flow cytometry shows CD5+, CD19+, CD23+, weak surface immunoglobulin. He is asymptomatic. What is the most likely diagnosis?

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Correct answer: B — Chronic lymphocytic leukaemia

Lymphocytosis with mature lymphocytes, smear cells, and CD5+/CD19+/CD23+/weak sIg immunophenotype is diagnostic of CLL. Asymptomatic early-stage (Binet A/Rai 0) CLL is managed with watch-and-wait. Treatment is indicated for symptomatic disease or progressive cytopenias. First-line is now BTK inhibitors (ibrutinib, acalabrutinib) or venetoclax-obinutuzumab.

Reference: iwCLL – 2024 – CLL Guidelines; ALLG/HSANZ Australian CLL Recommendations