skip to main content

Del(17p) CLL Treatment — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardHaematologyDel(17p) CLL TreatmentRACP Adult Medicine

A 70-year-old man with CLL (Rai stage III, bulky lymphadenopathy, Hb 88 g/L, platelets 85 × 10⁹/L) requires treatment. FISH shows del(17p). IGHV is unmutated. He has well-controlled hypertension and no AF. What is the most appropriate first-line treatment?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Ibrutinib (BTK inhibitor)

Del(17p)/TP53 mutation renders CLL resistant to chemoimmunotherapy (FCR, BR, chlorambucil-based). Targeted therapy is mandatory. BTK inhibitors (ibrutinib, acalabrutinib, zanubrutinib) or venetoclax-based regimens are first-line for del(17p) CLL. Zanubrutinib or acalabrutinib are preferred over ibrutinib (fewer cardiovascular side effects). Venetoclax + obinutuzumab (fixed-duration) is the main alternative.

Reference: ALLG – 2024 – CLL Guidelines; iwCLL 2024; NCCN 2025