Managing Relapsed Follicular Lymphoma

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Managing Relapsed Follicular Lymphoma

June 2015

  • A 65-year old female presented to her PCP complaining of night sweats and swelling in the neck
  • PMH: osteoporosis, neurogenic bladder
  • Physical examination:
    • Enlarged spleen 2 cm. below costal margin, bilateral cervical and axillary lymphadenopathy
  • ECOG 0
  • Laboratory findings:
    • WBC: 12 x 109/L; 45% lymphocytes
    • Hb: 11.5 g/dL
    • Platelets: 213 x 109/L
    • LDH 212 U/L
  • Excisional biopsy of the lymph nodes:
    • IHC: CD10+, BCL2+
    • Follicular lymphoma, grade IIIa
  • Bone marrow biopsy, 40% involved
  • 18FDG-PET showed SUVmax of 9 with discrete masses bilaterally in the cervical and axillary region and increased uptake in the liver
  • FLIPI 4 points, high risk
  • The patient was started on bendamustine + rituximab (6 cycles) and was continued on rituximab maintenance therapy for 12 months
  • She achieved a partial response with a 75% reduction in tumor volume

February 2018

  • After 32 months, the patient complained of her symptoms returning
  • CT showed disease progression in the axillary and hilar lymph nodes
  • PET with SUV of 11
  • Re-biopsy of lymph node, consistent with follicular lymphoma grade IIIa
  • The patient was referred to an academic center for treatment
  • She was enrolled in an open-label clinical trial of lenalidomide/rituximab (12 cycles)
  • She achieved partial remission after 3 months

February 2019

  • Twelve months later, the patient presents with low-grade fever and chills, she is otherwise well-appearing and continues to exercise regularly
  • ECOG 0
  • PET-CT showed further progression in the axillary lymph nodes
  • The patient was treated with IV copanlisib and achieved a partial response after 4 cycles; she continues to do well on therapy

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