A 66-Year-Old Woman With Mantle Cell Lymphoma

August 28, 2020
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.


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