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