ONCAlert | 2018 ASCO Annual Meeting
Mantle Cell Lymphoma Case Studies

Case Studies: Stage IV High-Risk Mantle Cell Lymphoma

Lymphoma expert Brad S. Kahl, MD, discusses the case of an elderly male with advanced high-risk mantle cell lymphoma, including the use of ibrutinib as second-line therapy after immunochemotherapy.

Stage IV High-Risk Mantle Cell Lymphoma

April 2016

  • A 72-year-old male presents to his physician complaining of night sweats, intermittent fever (101°-102°) and fatigue lasting 2 months
  • PMH: remarkable for hypertension; controlled on a beta-blocker and diuretic
  • Physical exam:
    • Right supraclavicular lymph node, markedly enlarged
    • Spleen, palpable
  • Laboratory findings:
    • Leukocytes, 6.73 X 109/L
    • LDH, 420 U/L
  • Excisional biopsy of the right supraclavicular node:
    • Immunophenotyping: IgD+, CD5+, CD10+, CD19+, CD20+, CD22+, CD23-, cyclin D1+
    • Cytogenetics: t(11;14)(q13;q32)
    • Bone marrow biopsy confirmed the presence of cyclin D1+ lymphoid cells
  • PET-CT: diffuse 18F-FDG uptake in lymph nodes and spleen; the largest involved nodes are the right supraclavicular (4.2 cm), right mesenteric (3.8 cm), and splenic hilar (5.7 cm) nodes
  • Diagnosis: Mantle-cell lymphoma, Ann Arbor stage IV
  • The patient was started on therapy with bendamustine + rituximab

November 2016

  • PET/CT findings at 3 months and 6 months showed a partial response to upfront chemoimmunotherapy
  • The patient continues to report symptoms of fatigue
  • He was started on therapy with ibrutinib
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