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Chronic Lymphocytic Leukaemia — RACP Adult Medicine MCQ

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EasyHaematologyChronic Lymphocytic LeukaemiaRACP Adult Medicine

A 70-year-old man with newly diagnosed chronic lymphocytic leukaemia (CLL) has Rai stage 0 disease with a lymphocyte count of 25 × 10⁹/L. He is asymptomatic. What is the most appropriate management?

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Correct answer: A — Watch and wait with regular monitoring

Early-stage (Rai 0–II, Binet A) asymptomatic CLL should be managed with watch and wait. Multiple trials have shown no survival benefit from early treatment in asymptomatic disease. Treatment is initiated when the patient develops progressive symptoms, cytopaenias, massive lymphadenopathy/splenomegaly, or rapidly doubling lymphocyte count. Prognostic markers (IGHV, TP53, FISH) should be assessed at diagnosis.

Reference: eTG – 2025 – Haematology; iwCLL – 2018 – CLL Treatment Guidelines