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|Videos|August 28, 2020
A 66-Year-Old Woman With Mantle Cell Lymphoma
Author(s)Javier Munoz, MD, MS, FACP
Javier Munoz, MD, MS, FACP, of the Mayo Clinic, considers the appropriateness for CAR T-cell therapy for a 66-year-old woman with relapsed/refractory mantle cell lymphoma.
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Case: A 66-Year-Old Woman With Mantle Cell Lymphoma
History
- A 66-year-old woman diagnosed with mantle cell lymphoma in 2017
- She was treated with rituximab, dexamethasone, cytarabine + carboplatin followed by autologous stem cell rescue; achieved PR;
- Continued on rituximab maintenance therapy
- In 2019 she experienced clinical relapse and was started on acalabrutinib; achieved SD
Currently
- She complains of a 3-month history of intermittent fatigue, nausea and dyspnea on exertion
- PMH: DM, medically controlled
- PE: bilateral submandibular lymphadenopathy; otherwise unremarkable
- Labs: WBC 12 X 109/L, hemoglobin 9.8 gm/dL, plt 90,000/u, LDH 410 U/I, ANC 3100/mm3
- Lymph node biopsy: IHC; cyclin D1+, CD10+, CD20+, CD43+; FISH: t (11;14)
- C/A/P CT scan: widespread lymphadenopathy including bilateral submandibular (2.9 cm, 3.4 cm), 2 left-sided axillary lymph nodes (3.7 cm, 4.1 cm), and lumbar region (5.1 cm)
- PET/CT shows diffuse uptake of 18F-FDG in the submandibular, axillary and lumbar lymph nodes
- Beta-2-microglobulin 4.2 µg/L
- Ann Arbor stage IV; MIPI score 6.6, high risk; ECOG PS 0
- Treatment was started with fludarabine + cyclophosphamide, followed by a single infusion of CAR transduced autologous T cell
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