Hematologic Malignancies USMLE Step 1 Practice Question
A 68-year-old man presents to his hematologist for routine follow-up of chronic lymphocytic leukemia diagnosed 12 years ago. He remains asymptomatic with no fever, night sweats, or weight loss. Physical examination reveals mild cervical lymphadenopathy and a palpable spleen tip. Laboratory studies show hemoglobin 9.1 g/dL, white blood cell count 18,500/μL with 78% lymphocytes, and platelets 48,000/μL. Flow cytometry confirms CD5+, CD19+, CD23+ B-cell population. Cytogenetic analysis demonstrates deletion 17p and TP53 mutation. Which of the following best describes the prognostic significance of this genetic finding?
Answer choices
- ADeletion 17p with TP53 mutation predicts rapid disease progression, shorter overall survival, and poor response to conventional chemotherapyCorrect answer
- BTP53 mutation is a favorable prognostic marker associated with long-term remissions following standard chemotherapy
- CDeletion 17p indicates an indolent course that typically does not require treatment for many years
- DThis genetic profile is associated with transformation to Richter syndrome in >80% of patients within 2 years
- ETP53 deletion is a neutral prognostic finding with outcome dependent primarily on age and performance status
- FDeletion 17p predicts intermediate-risk disease with durable responses to fludarabine-based regimens
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