A 74-Year-Old Man With Diffuse Large B-Cell Lymphoma

September 23, 2020

Gilles Salles, MD, reviews the case of a 74-year-old man with diffuse large B-cell lymphoma.


Case: A 74-Year-Old Man with Diffuse Large B-Cell Lymphoma

Initial Presentation

  • A 74-year-old man presented with fever, 14-lb unintentional weight loss and occasional chest pain
  • PMH: DM, medically controlled
  • PE: tired-appearing man; palpable bilateral cervical lymphadenopathy

Clinical Work-up

  • Labs: LDH 2 times above normal; Hb 10.8 g/dL; bilirubin 2.3 mg/dL; creatinine 1.7 mg/fl; all others WNL
  • Hepatitis B, C and HIV negative
  • Lymph node biopsy; CD 20+ confirmed DLBCL; IHC panel: CD 10+, CD 19+
  • Imaging:
    • Whole body PET/CT scan showed activity the cervical lymph node region, largest node 2.5 cm; evidence of axillary and thoracic subcutaneous tissue involvement
  • Ann Arbor stage 4; IPI: high-risk; ECOG PS 1

Treatment

  • Treatment initiated with R-CHOP + RT; well-tolerated
    • Interim PET scan after 4 cycles; progressive diseases noted
  • Due to transplant ineligibility patient was treated with tafasitamab + lenalidomide