A 72-Year-Old Man With Symptomatic Follicular Lymphoma
A 72-Year-Old Man With Symptomatic Follicular Lymphoma
Case: A 72-Year-Old Man With Symptomatic Follicular Lymphoma
Initial Presentation
A 72-year-old man presented to his physician with fatigue, and an involuntary 9-lb weight loss over the last 3 months. He complained of intermittent night sweats and decrease activities of daily living
Clinical work-up
- PE: Splenomegaly, firm nontender, rubbery lymph nodes on palpation in left axillary and bilateral inguinal region
- CBC: WBC, 13.6 X 104/L, platelets, 114 X 109/L, Hb, 8.9 g/dL, LDH, 380 U/L
- Beta 2 microglobulin 3.4 µg/mL
- HIV, HBV-, HCV-negative
- Excisional biopsy showed grade 3 follicular lymphoma; CD10+, CD23+
- Bone marrow biopsy; 50% involved
- PET/CT showed widespread lymphadenopathy above and below the diaphragm: largest lymph node measuring 7.6 cm, spleen measuring at 12.3 cm
- Diagnosis: Grade 3A, Stage IVB follicular lymphoma
- FLIPI2 score: high-risk
- ECOG PS 1
Treatment
- Patient started on obinutuzumab + CVP q8W of 21-day cycles
- Post-therapy PET showed partial response
- Continued on obinutuzumab 1000 mg q8W for 12 doses as monotherapy, well-tolerated
Follow-up
- PET scan at 12 months was negative
- Completed treatment; after 24 months of obinutuzumab maintenance remains in on-going remission
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