A 71-Year-Old Woman with Relapsed/Refractory DLBCL
Matthew Lunning, DO, presents a case study of a 71-year-old woman with relapsed/refractory diffuse large B-cell lymphoma.
Case: A 71-Year-Old Woman with R/R DLBCL
Initial presentation
- A 71-year-old woman presented with fatigue, weight loss and pruritus
- PMH: HTN, medically controlled
- PE: palpable axillary and femoral lymphadenopathy; palpable spleen 3 cm below the midclavicular line
- ECOG PS 1
Clinical Workup
- Labs: Hb 9.8 g/dL, LDH 2x ULN; renal and hepatic function WNL
- Hepatitis B, C and HIV negative
- Excisional biopsy of a right enlarged axillary lymph node confirmed DLBCL, GCB subtype
- IHC positive for: CD10, CD20
- FISH panel: t(14;18) translocation with BCL2 rearrangement, no MYC or BCL2 rearrangements
- Flow cytometry: CD19-postitive
- Whole body PET/CT scan showed FDG avidity in the bilateral axillary and femoral regions, largest lymph node 3.6 cm in right axillary space; splenomegaly
- Bone marrow biopsy showed involvement of DLBCL in the bone marrow
- Ann Arbor stage IVa DLBCL, GCB subtype
- IPI score high-risk
Treatment
- Treated with R-CHOP x 6 cycles
- First post-treatment PET/CT scan unremarkable; metabolic CR based on Deauville criteria
- 9 months later there was relapse of disease with new cervical and mediastinal lymphadenopathy
- Core needle biopsy of a cervical lymph node confirms a relapse of DLBCL, GCB subtype
- She was offered ASCT but deferred
- Initiated tafasitamab + lenalidomide
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