A 71-Year-Old Woman with Relapsed/Refractory DLBCL

Case: A 71-Year-Old Woman with R/R DLBCL

Initial presentation

• A 71-year-old woman presented with fatigue, weight loss and pruritus
• PMH: HTN, medically controlled
• PE: palpable axillary and femoral lymphadenopathy; palpable spleen 3 cm below the midclavicular line
• ECOG PS 1
  
  

Clinical Workup

• Labs: Hb 9.8 g/dL, LDH 2x ULN; renal and hepatic function WNL
• Hepatitis B, C and HIV negative
• Excisional biopsy of a right enlarged axillary lymph node confirmed DLBCL, GCB subtype
• IHC positive for: CD10, CD20
• FISH panel: t(14;18) translocation with BCL2 rearrangement, no MYC or BCL2 rearrangements
• Flow cytometry: CD19-postitive
• Whole body PET/CT scan showed FDG avidity in the bilateral axillary and femoral regions, largest lymph node 3.6 cm in right axillary space; splenomegaly
• Bone marrow biopsy showed involvement of DLBCL in the bone marrow
• Ann Arbor stage IVa DLBCL, GCB subtype
• IPI score high-risk

Treatment

• Treated with R-CHOP x 6 cycles
• First post-treatment PET/CT scan unremarkable; metabolic CR based on Deauville criteria
• 9 months later there was relapse of disease with new cervical and mediastinal lymphadenopathy
• Core needle biopsy of a cervical lymph node confirms a relapse of DLBCL, GCB subtype
• She was offered ASCT but deferred
• Initiated tafasitamab + lenalidomide