Case Review: Progression in Follicular Lymphoma
Case Review: Progression in Follicular Lymphoma
Case:A 70-Year-Old Man With Follicular Lymphoma
H & P:
- A 70-year-old man presents with night sweats and general fatigue
- PMH: hypertension, no history of MACE
- PE: Groin is tender to touch, no tenderness in abdomen
- Initially diagnosed with bilateral axillary contiguous stage II FL 5.5 years ago
- Grade 2 FL, 4 masses (each >3 cm)
- FLIPI status: high risk
Current biopsy and labs:
- Biopsy: grade 2 FL without transformation
- ECOG performance status: 1
- Hematologic results
- ANL: 1200 /µL
- Platelets: 105,000 /µL
- Hemoglobin: 11.9 g/dL
- LDH: 335 U/L
- eGFR: 75 mL/min/1.732
- Imaging: PET/CT reveals inguinal lymphadenopathy, with largest mass 8.5 cm
Treatment and disease history
- Front-line BR
- Completed 6 cycles, achieved PR by 3 months
- Maintained PR for 20 months before developing fever and mediastinal lymphadenopahty
- Second-line R-CHOP
- Competed 6 cycles, achieved PR at 3 months
- PR maintained for 5 months
- Time since completion of last treatment: 5 months
Current treatment
- Started on single-agent idelalisib 150 mg twice a day
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