A 76-Year-Old Woman With High Risk Mantle Cell Lymphoma

June 18, 2020
Kami Maddocks, MD

Kami Maddocks, MD, reviews the case of a 76-year-old woman with stage 4 mantle cell lymphoma and evaluates the role of BTK inhibitors in the treatment of relapsed/refractory disease.


Case: A 76-Year-Old Woman with High Risk Mantle Cell Lymphoma

Initial presentation

  • A 76-year-old woman presented with a 2-month history of occasional night sweats, intermittent fatigue and decreased appetite
  • PMH: DM, medically controlled; GERD controlled on OTC medication
  • PE: bilateral cervical lymphadenopathy, splenomegaly

Clinical workup

  • LDH 405 U/I, ANC 3200/mm3, beta-2-microglobulin 4.1 µg/L, leukocytes, 5.42 X 109/L, hemoglobin 9.1 gm/dL
  • FISH: t(11;14)
  • Immunocytochemistry: cyclin D1+, CD5+, CD20+, CD43+, CD10-, CD23-
  • Bone marrow biopsy positive for lymphoid cells with cyclin D1
  • PET/CT scan showed widespread lymphadenopathy including inguinal node (5.1 cm) and splenomegaly
  • Ann Arbor stage IV; MIPI score 6.4; ECOG PS 0

Treatment

  • She was started on bendamustine + rituximab
    • Achieved PR
    • Continued on maintenance rituximab q8W
  • At 18 months the patient had clinical disease relapse, including an unintentional 7-lb weight loss
    • She was started on ibrutinib 560 mg PO qDay
    • Imaging at 10-week follow-up showed substantial decrease in disease burden