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|Videos|May 18, 2020
A 68-Year-Old Man With Mantle Cell Lymphoma
Author(s)Jonathon B. Cohen, MD, MS
Recommendations for treating a 68-year-old male with mantle cell lymphoma with a BTK inhibitor once he has relapsed on prior therapy.
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Case: A 68-Year-Old Male with Mantle Cell Lymphoma
Initial presentation
- A 68-year-old man presented with generalized lymphadenopathy, fatigue and an unintentional 8-lb weight loss
- PMH: HTN, medically controlled
- PE: abdominal distention, splenomegaly
Clinical workup
- LDH 345 U/I, ANC 3500/mm3, beta-2-microglobulin 4.4 µg/L, leukocytes, 5.98 X 109/L, hemoglobin 9.6 gm/dL
- FISH: t (11;14)
- Immunocytochemistry: cyclin D1+, CD5+, CD20++
- BMB positive for lymphoid cells with cyclin D1
- PET/CT scan showed widespread lymphadenopathy in numerous nodal regions including left mesenteric (3.4 cm), bilateral axillary (3.9 cm, 5.3 cm), and cervical (5.1 cm)
- Ann Arbor stage IV; MIPI score 6.3; ECOG PS 1
Treatment
- Patient was started on bendamustine + rituximab
- Achieved PR
- Continued on maintenance rituximab q8W
- At 9 months the patient had clinical disease relapse
- He was started on ibrutinib 560 mg PO qDay
- Imaging at 12-week follow-up showed no evidence of disease
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