ONCAlert | 2017 San Antonio Breast Cancer Symposium
Follicular Lymphoma Case Studies

Case Studies: Risk-Based Management of Follicular Lymphoma

In this case-based interview, Ajay Gopal, MD, provides an overview on risk assessment and therapeutic management for patients with follicular lymphoma.

Risk-Based Management of Follicular Lymphoma: Case 2

January 2014

  • A 66-year-old male presents with bilateral inguinal and right axillary adenopathy.
  • Past medical history includes hypercholesterolemia managed with simvastatin; moderate hypertension, managed with hydrochlorothiazide/triamterene; history of atrial fibrillation managed with apixaban.
    • Laboratory findings: hemoglobin level 10.2 g/dL, LDH elevated
    • CT scan shows widely disseminated disease, with bulky adenopathy in the pelvis, mesentery, retroperitoneum, supraclavicular region, and aortopulmonary window. The largest lymph node is 9.8 cm.
    • Chest radiography shows small bilateral pleural effusions
    • Bone marrow biopsy shows 70% involvement with FL
    • Excisional biopsy shows grade 2 follicular lymphoma
  • The patient was started on R-CHOP and achieved remission for 19 months at which time he developed an enlarging adenopathy in the pelvis.

October 2015

  • Upon relapse of her disease, the patient was treated with bendamustine/rituximab.
  • He achieved a partial response for close to 6 months.

April 2016

  • The patient reports feeling tired and abdominal fullness.
  • Physical exam remarkable for palpable splenomegaly.
  • PET imaging showed enlargement of pelvic and retroperitoneal nodes and development of several new lesions.
  • The patient was started on idelalisib therapy.
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