Case Clinic Challenge: A 63-year-old male, relapsed CLL, 17 p deletion, recurrent bulky lymphadenopathy

Chronic lymphocytic leukemia (CLL) presents as a spectrum of disease that warrants careful diagnostic and prognostic considerations, including immunophenotyping and risk stratification based on multiple molecular markers. Best practices for the diagnosis, prognosis estimations, treatment, and monitoring of a 68-year-old female patient with newly diagnosed CLL are reviewed. Following determination that the patient is high risk with a poor prognosis, treatment options are reviewed using a shared decision-making model.

 

As a provider approved by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of the Johns Hopkins University School of Medicine Office of Continuing Medical Education (OCME) to require signed disclosure of the existence of financial relationships with industry from any individual in a position to control the content of a CME activity sponsored by OCME. Members of the planning committee are required to disclose all relationships regardless of their relevance to the content of the activity. Faculty are required to disclose only those relationships that are relevant to their specific presentation. 

 

It is the policy of the Institute for Johns Hopkins Nursing to require our continuing nursing education program faculty and planning committee members to disclose any financial relationships with companies providing program funding or manufacturers of any commercial products discussed in the program.

No planner has indicated that he/she has any financial interests in or relationships with a commercial entity.

Note: Grants to investigators at the Johns Hopkins University are negotiated and administered by the institution which receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored project(s) are not directly compensated by the sponsor, but may receive salary or other support from the institution to support their effort on the project(s).

 

Haymarket Medical Education staff report that they do not have financial relationships with companies providing program funding and/or manufacturers of any commercial products.

 

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Johns Hopkins University School of Medicine and the Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

 

The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

 

Johns Hopkins University School of Medicine designates this enduring material for a maximum of .50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

This .50-contact hour enduring activity is provided by the Institute for Johns Hopkins Nursing. Contact hours will be awarded for this enduring activity until April 6, 2017. Approval Code: PO103-2016/0161

 

The following author has disclosed that his case will reference unlabeled/unapproved uses of drugs or products:  

 

Neil E. Kay, MD, references ibrutinib, idelalisib, and obinutuzumab.

 

The Johns Hopkins University School of Medicine/Business of Medicine: Improving Health Care Delivery Skills (EM) may include presentations on drugs or devices, or use of drugs or devices, that have not been approved by the US Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or device he or she wishes to use in clinical practice.

The Johns Hopkins University School of Medicine is committed to the free exchange of medical education. Inclusion of any presentation in this program, including presentations on off-label uses, does not imply an endorsement by Johns Hopkins of the uses, products, or techniques presented.

 

The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine or the Institute for Johns Hopkins Nursing name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients.

To obtain credit, a score of 70% or better on the post-test is required. This activity is offered at no cost to participants. Please proceed with the activity until you have successfully completed this program, answered all test questions, completed the post-test and evaluation, and have received a digital copy of your credit certificate. Your online certificate will be saved on myCME within your Profile/CME History, which you can access at any time.

 

For CME questions, please contact the Johns Hopkins OCME office at (410) 955-2959 or cmenet@jhmi.edu.

 

If you have any questions relating to the CNE accreditation of this activity, please contact IJHN@jhmi.edu.