Ajay K. Gopal, MD

Diagnosis of a 69-Year-Old Woman With Follicular Lymphoma

Follicular Lymphoma: Prognostic Scoring and Treatment Decisions

Maintenance Therapy for Follicular Lymphoma

Follicular Lymphoma: Treating Early Progression

PI3K Inhibition for R/R Follicular Lymphoma

Treating R/R Follicular Lymphoma With PI3K Inhibitors

Novel Therapies for Patients With Follicular Lymphoma

Case:A 69-Year-Old Woman With Follicular Lymphoma

A 69-year-old woman complains of a 5-month history of fatigue, decreased appetite and a 10-bs. weight loss

PE: right axillary and bilateral cervical lymph nodes palpated ~ 3 cm; spleen palpable 4 cm below costal margin



Labs: ANC 1.6 x 109/L, WBC 11.8 x 109/L, 40% lymphocytes, Hb 8.9 g/dL, plt 98 x 109/L, LDH 308 U/L, B2M 3.7 µg/mL; HBV negative

Excisional biopsy of the lymph node on IHC showed CD 20+, CD 10+, BCL2+; follicular lymphoma grade 2

Bone marrow biopsy showed paratrabecular lymphoid aggregates, 45% involvement

PET/CT showed enlargement of right axillary lymph nodes (3.1 cm, 3.2 cm), diffusely enlarged nodes in the retroperitoneal and lumbar lymph nodes

She was treated with R-CHOP for 6 cycles with rituximab maintenance; achieved partial response

5 months later she complained of increasing fatigue

Repeat PET/CT revealed progression of disease

She was started on bendamustine + obinutuzumab for 6 cycles and continued maintenance obinutuzumab

Repeat lymph node biopsy remained grade 1-2 follicular lymphoma

9 months later she complained of chills and low-grade fever

She was started on idelalisib 150 mg PO BID

Videos

Ajay K. Gopal, MD, discusses the rationale for treating a 69-year-old woman with high-risk follicular lymphoma with a PI3-kinase inhibitor in the third-line setting.

Ajay K. Gopal, MD | Authors

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A 69-Year-Old Woman With Follicular Lymphoma