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

Case Studies: Treatment of Follicular Lymphoma

In this case-based interview, Loretta Nastoupil, MD, provides an overview on the diagnosis and therapeutic management of follicular lymphoma. The case of a newly-diagnosed patient and the case of a patient with high-risk progressive disease are discussed.

Treatment of Follicular Lymphoma: Case 2

February 2015

  • A 44-year-old man presented to his physician with submandibular swelling. He reports losing weight over the past few months.
  • Excisional biopsy showed grade 2 follicular lymphoma that was positive for CD20, CD10, Bcl-6 and Bcl-2 co-expression, and t(14;18); KI-67, 15%
  • Imaging showed widespread lymphadenopathy and a large mesenteric mass measuring 11.2 cm
  • LDH elevated (400 U/L), stage IV follicular lymphoma with bone marrow involvement
  • The patient was started on R-CHOP
  • PET/CT imaging at end of therapy was consistent with a complete remission.

November 2015

  • Follow-up PET/CT at 9 months showed increasing size of the mesenteric mass and progression in the axillary lymph nodes.
  • A biopsy was pursued at that time confirming relapsed follicular lymphoma.
  • The patient was initiated on obinutuzumab + bendamustine with plan for obinutuzumab maintenance.

October 2016

  • Eleven months later, the patient reported having fever and fatigue along with increased swelling in the submandibular node.
  • PET/CT showed widespread progression with increased size of the mesenteric mass to 12.5 cm and 3 new lesions (3.2 cm, 2.4 cm, 1.8 cm) in the inguinal region.
  • The patient was started on therapy with idelalisib.
  • He experienced severe diarrhea from this treatment which was successfully managed with enteric budesonide and systemic corticosteroids.
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