MEDizzy - A 71-year-old woman with no significant past medical history

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Combined Hematology

A 71-year-old woman with no significant past medical history is investigated for lymphocytosis. She has recently lost 7kg in weight and complains of lethargy. The following blood results are obtained: Hb 9.8 g/dl Plt 104 * 109/l WBC 70.3 * 109/l Blood film: Lymphocytosis. Smudge cells seen Four months previously her white cell count was 30.5 * 109/l. What is the most appropriate management?

ExplanationD. CLL - treatment: Fludarabine, Cyclophosphamide and Rituximab (FCR) This patient has chronic lymphocytic leukemia. The lymphocyte doubling time is less than 6 months, the patient has some evidence of marrow failure and also has systemic symptoms. She should therefore be treated and of the options given a combination of fludarabine, cyclophosphamide and rituximab (FCR) is the most appropriate treatment. Chlorambucil used to be the first-line treatment of choice but studies have shown it not to be as effective as FCR. As with many hematological cancers such patients are often entered into randomized trials