A 77-Year-Old Woman with DLBCL

Case: A 77-Year-Old Woman With DLBCL

Initial Presentation

• A 77-year-old woman presented with loss of appetite, fatigue and shortness of breath
• PMH: post-menopausal; DM, medically controlled
• PE: palpable inguinal lymphadenopathy; splenomegaly
• ECOG PS 1
  
  

Clinical Work-up

• Labs: Hb 9.8 g/dL; all others WNL
• FEV1 45 %
• Hepatitis B, C and HIV negative
• Core needle biopsy of the inguinal node: CD20-positive diffuse large B-cell lymphoma, non-GCB subtype. FISH panel: t(14;18) with a BCL2 rearrangement; no MYC or BCL6 rearrangement
• Imaging:
  • Whole body PET/CT scan showed FDG avidity the inguinal lymph node region, largest node 3.3 cm; splenomegaly; and a small suspicious lung lesion
• Bone marrow biopsy: involvement with DLBCL
• Conclusion: stage IV DLBCL, non-GCB subtype
• IPI score high-risk; CNS relapse score intermediate risk

Treatment

• Treated with R-CHOP for 6 cycles
• End-of-treatment PET/CT demonstrates a Deauville 2 complete remission
• 1 year later while in surveillance she presents with new cervical, axillary, mediastinal, and abdominal lymphadenopathy
• Core needle biopsy of an axillary node confirms a relapse of DLBCL, non-GCB subtype
• Based on her age of 78 years and performance status, you consider her to be transplant-ineligible
• You elect to initiate tafasitamab + lenalidomide