A 76-Year-Old Woman With High Risk Mantle Cell Lymphoma
Kami Maddocks, MD, reviews the case of a 76-year-old woman with stage 4 mantle cell lymphoma and evaluates the role of BTK inhibitors in the treatment of relapsed/refractory disease.
Case: A 76-Year-Old Woman with High Risk Mantle Cell Lymphoma
Initial presentation
- A 76-year-old woman presented with a 2-month history of occasional night sweats, intermittent fatigue and decreased appetite
- PMH: DM, medically controlled; GERD controlled on OTC medication
- PE: bilateral cervical lymphadenopathy, splenomegaly
Clinical workup
- LDH 405 U/I, ANC 3200/mm3, beta-2-microglobulin 4.1 µg/L, leukocytes, 5.42 X 109/L, hemoglobin 9.1 gm/dL
- FISH: t(11;14)
- Immunocytochemistry: cyclin D1+, CD5+, CD20+, CD43+, CD10-, CD23-
- Bone marrow biopsy positive for lymphoid cells with cyclin D1
- PET/CT scan showed widespread lymphadenopathy including inguinal node (5.1 cm) and splenomegaly
- Ann Arbor stage IV; MIPI score 6.4; ECOG PS 0
Treatment
- She was started on bendamustine + rituximab
- Achieved PR
- Continued on maintenance rituximab q8W
- At 18 months the patient had clinical disease relapse, including an unintentional 7-lb weight loss
- She was started on ibrutinib 560 mg PO qDay
- Imaging at 10-week follow-up showed substantial decrease in disease burden
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