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Follicular Lymphoma Case Studies

Case Studies: A 59-Year-Old Man With Relapsed Follicular Lymphoma

Jonathan Friedberg, MD, discusses the clinical features, diagnostic work-up, treatment options, and the future advancements in follicular lymphoma.

A 59-Year-Old Man With Relapsed Follicular Lymphoma

Case: A 59-Year-Old Man With Symptomatic Follicular Lymphoma

A 59-year-old man presented to his physician with a 10-lb weight loss and chronic night sweats for the past couple of months. He complained of intermittent fatigue but is able to maintain his current exercise regimen.

H & P

  • PE: enlarged bilateral axillary lymph nodes; enlarged spleen, palpable
  • CBC: WBC, 12 X 104 /L; platelets,103 X 109 /L; Hgb, 9.2 g/dL
  • LDH: 400 U/L

Biopsy

  • Excisional biopsy showed grade 2 follicular lymphoma; CD20+, CD10+
  • Bone marrow biopsy; 60% involved

Imaging

  • PET/CT showed widespread lymphadenopathy and a large splenic mass measuring 10 cm
  • Diagnosis: Stage IV follicular lymphoma

Teatment

  • Started on R-CHOP; tolerated induction well
  • Post-therapy PET showed partial remission
  • Followed by Rituximab maintenance until evidence of disease progression

Follow-up

  • Core needle biopsy; performed confirmed persistent follicular lymphoma; no transformation
  • PET at 12 months showed increased size of splenic mass
  • ECOG, 0
  • Patient started on obinutuzumab + bendamustine
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