A 59-Year-Old Man With Relapsed Follicular Lymphoma
A 59-Year-Old Man With Relapsed Follicular Lymphoma
Case: A 59-Year-Old Man With Symptomatic Follicular Lymphoma
A 59-year-old man presented to his physician with a 10-lb weight loss and chronic night sweats for the past couple of months. He complained of intermittent fatigue but is able to maintain his current exercise regimen.
H & P
- PE: enlarged bilateral axillary lymph nodes; enlarged spleen, palpable
- CBC: WBC, 12 X 104/L; platelets,103 X 109/L; Hgb, 9.2 g/dL
- LDH: 400 U/L
Biopsy
- Excisional biopsy showed grade 2 follicular lymphoma; CD20+, CD10+
- Bone marrow biopsy; 60% involved
Imaging
- PET/CT showed widespread lymphadenopathy and a large splenic mass measuring 10 cm
- Diagnosis: Stage IV follicular lymphoma
Teatment
- Started on R-CHOP; tolerated induction well
- Post-therapy PET showed partial remission
- Followed by Rituximab maintenance until evidence of disease progression
Follow-up
- Core needle biopsy; performed confirmed persistent follicular lymphoma; no transformation
- PET at 12 months showed increased size of splenic mass
- ECOG, 0
- Patient started on obinutuzumab + bendamustine
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