Case Presentation
A 51-year-old male patient presented with skin masses, 10cm X 5 cm
(figure 1), in May 2019. Biopsy showed Chronic Lymphocytic
Leukemia/Small Lymphocytic Lymphoma (CLL/SLL): diffuse infiltration by
small lymphocytes with the immunophenotype(IF) of CD5+, CD23+,
CD79a+>CD20+. Ki67% expression was 70%. Mild
lymphocytosis (lymphocytes=13910/mm3) and
lymphadenopathy without splenomegaly/hepatomegaly in computed
tomography(CT) scans were also present. CLL was IgVH unmutated and
deletion 17p/TP53 mutations were negative. The patient was treated with
the novel time-limited combination of
Venetoclax/Obinutuzumab1 from July 2019 until July
2020. The CLL skin component responded impressively (figure 2 and figure
3). Complete remission in CT scans and bone marrow biopsy was confirmed
at the end of treatment. Undetectable CLL minimal residual disease in
peripheral blood and bone marrow by 8-colour flow cytometry was also
confirmed. CLL skin involvement is a rare clinical presentation
especially at diagnosis. Ki67>45% is associated with more
aggressive biology of Non-Hodgkin lymphomas2. Our case
indicates that the novel time-limited treatment with the Venetoclax
/Obinutuzumab combination can eradicate the CLL disease, even with
unusual and biologically aggressive presentations.