American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with CLL who are unresponsive to treatment, which intervention is usually considered?

1. Hematopoietic stem cell transplant

2. High-dose chemotherapy

3. Splenectomy

4. Radiation therapy

The correct answer is: Splenectomy

Hematopoietic stem cell transplant is often the go-to intervention for patients with chronic lymphocytic leukemia (CLL) who are unresponsive to treatment. This procedure can address the underlying issue by providing the patient with healthy stem cells, which can repopulate the bone marrow and potentially lead to remission. It is especially considered for patients who have relapsed or refractory CLL, as it has the potential to offer a long-term cure. High-dose chemotherapy might be effective in certain settings, but it is typically not the primary choice for those who have already demonstrated resistance to standard treatments. Chemotherapy alone may not adequately target the underlying disease biology in these patients. Splenectomy, or surgical removal of the spleen, has been historically used in CLL management primarily for symptomatic splenomegaly or thrombocytopenia. However, it is not a standard treatment for unresponsive cases of CLL due to the lack of evidence supporting its effectiveness in changing the disease's course. Radiation therapy can be utilized for localized issues, such as painful lymphadenopathy, but it is not a general approach for treating unresponsive CLL. Instead, it is more symptomatic than curative in nature in the context of systemic disease like CLL