High-Risk Chronic Lymphocytic Leukemia in a Young Adult Treated With Reduced-Dosage, Fixed-Duration Ibrutinib and Venetoclax

Abstract

Chronic lymphocytic leukemia (CLL) is a disease primarily of the elderly; however, in rare cases, it can occur among adolescents and young adults (AYAs). While evidence-based guidelines are established, the guidelines include elderly with very limited data among young adults. CLL in AYA is deemed as high-risk disease. They experience longer survival than their older age counterparts, but this longevity increases their susceptibility to secondary cancers, CLL-related complications, and treatment-related adverse events. Thus, effective treatment requires a careful balance of efficacy and safety. A 32-year-old female presented with multiple neck masses, night sweats, weight loss, and easy fatigability. Workup revealed bicytopenia (anemia and thrombocytopenia). A cervical lymph node biopsy was compatible with small lymphocytic lymphoma (SLL); however, bone marrow aspiration with biopsy was done and signed out as CLL. Due to overlapping immuno-morphologic features, and her age, B-cell acute lymphoblastic leukemia cannot be entirely ruled out. Further testing with flow cytometry for basic leukemia panel and histopathology with immunohistochemistry favored a diagnosis of CLL. She was started on a reduced-dosage, fixed-duration ibrutinib and venetoclax. Since treatment initiation, patient had significant symptom improvement and no longer require blood transfusion. The report emphasized the need for individualized therapy to enhance outcomes and quality of life in young CLL patients. It discussed a rare case of a young adult with CLL, highlighting its diagnostic challenges, treatment, and outcomes. A fixed-duration, lower-dose regimen of ibrutinib and venetoclax appears to be a promising, safe, and effective treatment for CLL in young adults.