Factors for Treatment Decision-Making in R/R DLBCL
Dr Gilles Salles shares his opinion on the presented case’s treatment decision and the regimen he would have selected for the patient.
Case: A 51-Year-Old Woman with Diffuse Large B-Cell Lymphoma (DLBCL)
Case Description
A 51-year-old woman presented with fatigue and back pain that worsened in the past 3 months
History of mild hypertension (controlled with medication)
Physical exam: Left posterior cervical node, 1.7-cm; left anterior cervical node, 2.9-cm; right supraclavicular node, 2.5-cm
ECOG PS 0
CT scan: multiple enlarged mesenteric and retroperitoneal nodes, largest measuring 5.3 x 3.1 cm
Biopsy confirmed diffuse large B-cell lymphoma, IHC positive for:
CD20
BCL-6, MUM1
BCL-2 (50% of cells)
MYC (>90% of cells)
Ki67 83%
FISH: negative for MYC rearrangement/chromosomal abnormality
Normal CBC and LDH
Initial Treatment
Patient received 6 cycles of RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)
Back pain and fatigue resolved
Post-treatment PET scan results demonstrated a CR (Deauville score 2)
Patient was scheduled for follow-up visits at 3-month intervals
Follow-up Notes/Labs 9 Months After Completion of First-Line Therapy
Patient complained of increased fatigue and back pain, emergent fever and night sweats
A palpable lymph node in right groin was discovered on physical examination
PET and CT scans: new left inguinal lymph node, increase in size of residual node, as well as multiple metabolically active lesions in lymph nodes of the retroperitoneum, abdomen, and pelvis
Biopsy: DLBCL, non-germinal center B-cell
Second-Line Treatment
Patient was referred to transplant center
Patient received salvage RICE (rituximab, ifosfamide, carboplatin, etoposide)
PET-CT scan results after 2 cycles: Deauville score 5
Third-Line Treatment
When discussing next steps, the patient declined ASCT and CAR T-cell therapy due to the time commitment and travel required for administration, as well as financial concerns
The patient received polatuzumab vedotin/bendamustine/rituximab as 3rd-line treatment
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