A 59-Year-Old Man With Relapsed Follicular Lymphoma

Case: A 59-Year-Old Man With Symptomatic Follicular Lymphoma

A 59-year-old man presented to his physician with a 10-lb weight loss and chronic night sweats for the past couple of months. He complained of intermittent fatigue but is able to maintain his current exercise regimen.

H & P

• PE: enlarged bilateral axillary lymph nodes; enlarged spleen, palpable
• CBC: WBC, 12 X 10⁴/L; platelets,103 X 10⁹/L; Hgb, 9.2 g/dL
• LDH: 400 U/L

Biopsy

• Excisional biopsy showed grade 2 follicular lymphoma; CD20+, CD10+
• Bone marrow biopsy; 60% involved

Imaging

• PET/CT showed widespread lymphadenopathy and a large splenic mass measuring 10 cm
• Diagnosis: Stage IV follicular lymphoma

Teatment

• Started on R-CHOP; tolerated induction well
• Post-therapy PET showed partial remission
• Followed by Rituximab maintenance until evidence of disease progression

Follow-up

• Core needle biopsy; performed confirmed persistent follicular lymphoma; no transformation
• PET at 12 months showed increased size of splenic mass
• ECOG, 0
• Patient started on obinutuzumab + bendamustine