A 66-Year-Old Woman With Mantle Cell Lymphoma - Episode 1

Case Overview: 66-Year-Old Woman With MCL

August 28, 2020
Javier Munoz, MD, MS, FACP

Javier Munoz, MD, MS, FACP: I have been given the opportunity to discuss the case of a 66-year-old woman with mantle cell lymphoma. She was treated in 2017. She was treated with R-CHOP [rituximab cyclophosphamide, hydroxydaunorubicin hydrochloride, vincristine, prednisone] and R-DHAP [rituximab, dexamethasone, cytarabine, cisplatin], followed by autologous stem cell rescue, and she achieved a partial remission. She was subsequently prescribed rituximab maintenance. In 2019 she experienced a clinical relapse and was started on acalabrutinib, achieving stable disease.

Currently, she complains of a 3-month history of fatigue, nausea, and dyspnea. Her medical history includes having diabetes, which is medically well controlled. On physical exam, she has lymphadenopathy. Indeed, a new lymph node biopsy showed cyclin D1 positivity and CD10 and CD20 positivity, and the FISH [fluorescence in situ hybridization] showed the translocation of chromosomes 11 and 14. The imaging, not surprisingly, confirmed the physical findings of lymphadenopathy, widespread adenopathy above and below the diaphragm. A bone marrow biopsy confirmed that the patient had mantle cell lymphoma as well.

Treatment was started with lymphodepleting chemotherapy—fludarabine and cyclophosphamide—followed by a single infusion of CAR [chimeric antigen receptor] T cells.

Transcript edited for clarity.


Case: A 66-Year-Old Woman With Mantle Cell Lymphoma

History

  • A 66-year-old woman diagnosed with mantle cell lymphoma in 2017
  • She was treated with rituximab, dexamethasone, cytarabine + carboplatin followed by autologous stem cell rescue; achieved PR;
    • Continued on rituximab maintenance therapy
  • In 2019 she experienced clinical relapse and was started on acalabrutinib; achieved SD
     

Currently

  • She complains of a 3-month history of intermittent fatigue, nausea and dyspnea on exertion
  • PMH: DM, medically controlled
  • PE: bilateral submandibular lymphadenopathy; otherwise unremarkable
  • Labs: WBC 12 X 109/L, hemoglobin 9.8 gm/dL, plt 90,000/u, LDH 410 U/I, ANC 3100/mm3
  • Lymph node biopsy: IHC; cyclin D1+, CD10+, CD20+, CD43+; FISH: t (11;14)
  • C/A/P CT scan: widespread lymphadenopathy including bilateral submandibular (2.9 cm, 3.4 cm), 2 left-sided axillary lymph nodes (3.7 cm, 4.1 cm), and lumbar region (5.1 cm)
  • PET/CT shows diffuse uptake of 18F-FDG in the submandibular, axillary and lumbar lymph nodes
  • Beta-2-microglobulin 4.2 µg/L
  • Ann Arbor stage IV; MIPI score 6.6, high risk; ECOG PS 0
  • Treatment was started with fludarabine + cyclophosphamide, followed by a single infusion of CAR transduced autologous T cell