A 77-Year-Old Woman with DLBCL
John M. Burke, MD, of Rocky Mountain Cancer Centers, explains the rationale behind treating an elderly woman with relapsed diffuse large B-cell lymphoma with tafasitamab and lenalidomide after R-CHOP chemotherapy.
Case: A 77-Year-Old Woman With DLBCL
Initial Presentation
- A 77-year-old woman presented with loss of appetite, fatigue and shortness of breath
- PMH: post-menopausal; DM, medically controlled
- PE: palpable inguinal lymphadenopathy; splenomegaly
- ECOG PS 1
Clinical Work-up
- Labs: Hb 9.8 g/dL; all others WNL
- FEV1 45 %
- Hepatitis B, C and HIV negative
- Core needle biopsy of the inguinal node: CD20-positive diffuse large B-cell lymphoma, non-GCB subtype. FISH panel: t(14;18) with a BCL2 rearrangement; no MYC or BCL6 rearrangement
- Imaging:
- Whole body PET/CT scan showed FDG avidity the inguinal lymph node region, largest node 3.3 cm; splenomegaly; and a small suspicious lung lesion
- Bone marrow biopsy: involvement with DLBCL
- Conclusion: stage IV DLBCL, non-GCB subtype
- IPI score high-risk; CNS relapse score intermediate risk
Treatment
- Treated with R-CHOP for 6 cycles
- End-of-treatment PET/CT demonstrates a Deauville 2 complete remission
- 1 year later while in surveillance she presents with new cervical, axillary, mediastinal, and abdominal lymphadenopathy
- Core needle biopsy of an axillary node confirms a relapse of DLBCL, non-GCB subtype
- Based on her age of 78 years and performance status, you consider her to be transplant-ineligible
- You elect to initiate tafasitamab + lenalidomide
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