A 73-Year-Old Male With Mantle Cell Lymphoma

January 25, 2021
Brian T. Hill, MD, PhD

Brian Hill, MD, reviews the case of a 73-year-old man with mantle cell lymphoma and discusses the latest data and treatment approaches.


Case: A 73-Year-Old Male With Mantle Cell Lymphoma

History

  • A 73-year-old man was diagnosed with mantle cell lymphoma in 2016
  • He was treated with rituximab, dexamethasone, cytarabine + carboplatin followed by autologous stem cell transplant; achieved PR; continued rituximab maintenance therapy
  • Ann Arbor stage IV; MIPI score 6.7, high risk
  • Late 2019 he experienced clinical relapse and was started on ibrutinib; achieved SD
     

Currently

  • He complains of a 2-month history of loss of appetite and fatigue
  • PMH: hyperlipidemia, medically well-controlled
  • PE: bilateral clavicular and cervical lymphadenopathy; otherwise unremarkable
  • Labs: WBC 11 X 109/L, hemoglobin 9.5 gm/dL, plt 96,000/u, LDH 405 U/I, ANC 3200/mm3
  • Lymph node biopsy: IHC; cyclin D1+, CD5 +, CD10+, CD20+, FISH: t (11;14)
  • C/A/P CT scan: widespread lymphadenopathy including bilateral clavicular (2.4 cm, 1.5 cm), and inguinal region (4.6 cm)
  • PET/CT shows diffuse uptake of 18F-FDG in the clavicular, axillary and inguinal lymph nodes
  • Beta-2-microglobulin 4.1 µg/L
  • ECOG PS 0
  • Treatment was started with fludarabine + cyclophosphamide, followed by a single infusion of CAR T-cell therapy