American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for advanced chronic lymphocytic leukemia resistant to standard therapy?

1. Monoclonal antibody therapy

2. Palliative care only

3. Allogeneic hematopoietic stem cell transplantation

4. Chemotherapy

The correct answer is: Allogeneic hematopoietic stem cell transplantation

Allogeneic hematopoietic stem cell transplantation is a recommended treatment for advanced chronic lymphocytic leukemia (CLL) that is resistant to standard therapy. This approach is particularly valuable because it offers the potential for a curative outcome, especially for patients who have primary refractory disease or have experienced relapse after extensive treatment. The procedure involves transplanting stem cells from a healthy donor to the patient, which can help rebuild a patient's immune system and restore the ability to fight cancer. Allogeneic transplantation is typically considered for younger patients or those with less comorbidity, as it carries significant risks, including graft-versus-host disease (GVHD) and post-transplant complications. In contrast, monoclonal antibody therapy might be considered, but it generally serves as a bridge to a more definitive treatment such as transplantation rather than as a standalone option for advanced resistant CLL. Palliative care focuses on quality of life rather than curative treatment, which is not appropriate when seeking to address advanced resistant disease. Lastly, conventional chemotherapy may not be effective in patients with resistance to standard therapy, as the cancer has likely developed mechanisms to evade the effects of these agents. In summary, for patients with advanced CLL that is resistant to standard therapies,