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