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Marginal Zone Lymphoma Case Studies

Case Studies: Perspective on Treating Advanced Marginal Zone Lymphoma

John N. Allan, MD, discusses the case of a 65-year-old male with advanced marginal zone lymphoma and explains how to sequence next lines of therapy upon disease progression.

Perspective on Treating Advanced Marginal Zone Lymphoma

A 65-Year-Old Man With Advanced Nodal MZL

November 2014

History & Physical:

  • A 65-year-old man presented with multiple lumps in groin, no pain
  • PMH: negative for HCV, HBV, HIV
  • PE: marked swelling in right axillary and bilateral inguinal lymph nodes
    • ECOG performance status: 0
    • Otherwise healthy, no history of CV disease or diabetes, weight within normal range
  • CT revealed lymphadenopathy at multiple nodal sites with multiple involved nodes (each <2 cm) involved at each site; no extranodal involvement or bulky disease
  • Biopsies confirmed presence of B cell infiltrate
  • IHC: B cell phenotype CD20, CD19

Treatment History:

  • He was started on active monitoring with CT, histology, and pathology every 6 mo.

November 2015

  • At 12 months following diagnosis, disease progression was shown on imaging, with additional involved axillary nodes
  • The patient was started on treatment with bendamustine/rituximab (BR)

November 2017

  • Follow-up imaging at 2 years following initiation of BR revealed disease progression in multiple lymph nodes at several sites
    • 2 nodes measuring >3.0 cm
  • The patient was started on R-CHOP; he achieved a partial response

June 2018

  • 7 months later, the patient developed relapsed disease
  • He was started on treatment with ibrutinib 560 mg/day orally
    • He developed mild diarrhea (managed with OTC anti-diarrheal) and bruising on legs from minor bumps
    • Follow-up CBC showed grade 3 neutropenia without fever
  • Ibrutinib was discontinued until neutrophils recovered and restarted at same dose without incident
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