The patient is a 79-year-old male with a past medical history of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) status post treatment with Rituximab and Fludarabine, with partial respose. He was then started on Ofatumumab and posteriorly Obinutuzumab, with progression of disease. He presented with persistent fatigue, progressive leukocytosis and marked neutropenia. A bone marrow exam was obtained.