A 73-Year-Old Male With Mantle Cell Lymphoma

Case: A 73-Year-Old Male With Mantle Cell Lymphoma

History

• A 73-year-old man was diagnosed with mantle cell lymphoma in 2016
• He was treated with rituximab, dexamethasone, cytarabine + carboplatin followed by autologous stem cell transplant; achieved PR; continued rituximab maintenance therapy
• Ann Arbor stage IV; MIPI score 6.7, high risk
• Late 2019 he experienced clinical relapse and was started on ibrutinib; achieved SD
   

Currently

• He complains of a 2-month history of loss of appetite and fatigue
• PMH: hyperlipidemia, medically well-controlled
• PE: bilateral clavicular and cervical lymphadenopathy; otherwise unremarkable
• Labs: WBC 11 X 109/L, hemoglobin 9.5 gm/dL, plt 96,000/u, LDH 405 U/I, ANC 3200/mm3
• Lymph node biopsy: IHC; cyclin D1+, CD5 +, CD10+, CD20+, FISH: t (11;14)
• C/A/P CT scan: widespread lymphadenopathy including bilateral clavicular (2.4 cm, 1.5 cm), and inguinal region (4.6 cm)
• PET/CT shows diffuse uptake of 18F-FDG in the clavicular, axillary and inguinal lymph nodes
• Beta-2-microglobulin 4.1 µg/L
• ECOG PS 0
• Treatment was started with fludarabine + cyclophosphamide, followed by a single infusion of CAR T-cell therapy