Relapse After Second-Line Therapy in Follicular Lymphoma
May 8, 2019
Relapse After Second-Line Therapy in Follicular Lymphoma
Case:A 72-Year-Old Woman With Relapsed Follicular Lymphoma
H & P:
A 75-year-old woman presented with severe fatigue and weight loss
Was diagnosed with inguinal contiguous stage II follicular lymphoma (FL) 4.5 years ago; completed BR and achieved PR that persisted for almost 4 years
Started treatment with R-CHOP for extensive mediastinal FL 6 months ago; had achieved PR by 3 months before symptoms returned
PMH: Type 2 diabetes X 10 years, controlled on basal insulin and SGLT2 inhibitor
PE: Swelling present in right axillary lymph nodes; not tender to touch; no crackles or rales in lungs; no history of pneumonia; has received flu and PPV23 vaccination
ECOG performance status: 1
Biopsy showed grade 2 FL without transformation
Labs:
eGFR = 72 mL/min/1.732
AST/ALT: within normal range
ANL: 1350 /mm3
Platelets: 100,00 /µL
Hemoglobin: 10 g/dL
LDH: 275 U/L
Imaging: PET/CT revealed axillary lymphadenopathy, with largest mass 7.2 cm
She was started on idelalisib 150 mg b.i.d.
After 10 days, she called with concerns about diarrhea, which she has been experiencing on average 4 times daily for the past few days