A 59-Year-Old Man With Relapsed Follicular Lymphoma

October 22, 2019

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


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


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


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


  • 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