Relapse After Second-Line Therapy in Follicular Lymphoma
Relapse After Second-Line Therapy in Follicular Lymphoma
Case:A 72-Year-Old Woman With Relapsed Follicular Lymphoma
H & P:
- A 75-year-old woman presented with severe fatigue and weight loss
- Was diagnosed with inguinal contiguous stage II follicular lymphoma (FL) 4.5 years ago; completed BR and achieved PR that persisted for almost 4 years
- Started treatment with R-CHOP for extensive mediastinal FL 6 months ago; had achieved PR by 3 months before symptoms returned
- PMH: Type 2 diabetes X 10 years, controlled on basal insulin and SGLT2 inhibitor
- PE: Swelling present in right axillary lymph nodes; not tender to touch; no crackles or rales in lungs; no history of pneumonia; has received flu and PPV23 vaccination
- ECOG performance status: 1
- Biopsy showed grade 2 FL without transformation
- Labs:
- eGFR = 72 mL/min/1.732
- AST/ALT: within normal range
- ANL: 1350 /mm3
- Platelets: 100,00 /µL
- Hemoglobin: 10 g/dL
- LDH: 275 U/L
- Imaging: PET/CT revealed axillary lymphadenopathy, with largest mass 7.2 cm
- She was started on idelalisib 150 mg b.i.d.
- After 10 days, she called with concerns about diarrhea, which she has been experiencing on average 4 times daily for the past few days
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