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

Video

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
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1 expert in this video
1 expert in this video
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
Jamie L. Koprivnikar, MD, an expert on MDS
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