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