- A 66-year-old male presents with bilateral inguinal and right axillary adenopathy.
- Past medical history includes hypercholesterolemia managed with simvastatin; moderate hypertension, managed with hydrochlorothiazide/triamterene; history of atrial fibrillation managed with apixaban.
- Laboratory findings: hemoglobin level 10.2 g/dL, LDH elevated
- CT scan shows widely disseminated disease, with bulky adenopathy in the pelvis, mesentery, retroperitoneum, supraclavicular region, and aortopulmonary window. The largest lymph node is 9.8 cm.
- Chest radiography shows small bilateral pleural effusions
- Bone marrow biopsy shows 70% involvement with FL
- Excisional biopsy shows grade 2 follicular lymphoma
- The patient was started on R-CHOP and achieved remission for 19 months at which time he developed an enlarging adenopathy in the pelvis.
- Upon relapse of her disease, the patient was treated with bendamustine/rituximab.
- He achieved a partial response for close to 6 months.
- The patient reports feeling tired and abdominal fullness.
- Physical exam remarkable for palpable splenomegaly.
- PET imaging showed enlargement of pelvic and retroperitoneal nodes and development of several new lesions.
- The patient was started on idelalisib therapy.