Treatment of Relapsed Follicular Lymphoma with High Risk Status

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Treatment of Relapsed Follicular Lymphoma with High Risk Status

March 2012

  • A 57-year old woman presented with lymphadenopathy
  • PE: marked swelling in the right supraclavicular region, non-tender
  • Laboratory findings: platelets, 98,450/mL; HB, 10.9 g/dL
  • CT imaging showed a 4-cm right supraclavicular mass and a diffuse pattern of right-sided enlarged inguinal nodes
  • Incisional biopsy, pathology
    • IHC: CD10+, BCL2+, CD23(-), CD43(-), CD5(-) CD20(+), BCL6 (-)
    • Grade 2 follicular lymphoma, 12 centroblasts/HPF
  • FLIPI-intermediate
  • The patient was started on bendamustine/rituximab and achieved a partial response after 6 months

February 2016

  • Four years later, the patient complains of increasing fatigue
  • PET/CT shows intense FDG uptake in the right inguinal region and in the left hilar region; SUVmax of 9
  • The patient was started in lenalidomide + rituximab
    • After 3 months, her symptoms have resolved
    • After 6 months, she has achieved a partial response with significant shrinkage in the inguinal lymph node

February 2018

  • Two years later, the patient now age 63 years, reports having severe fatigue and weight loss; she requires frequent rest during the days and has trouble keeping up with daily activities
  • Performance Status, ECOG 1
  • Laboratory findings: platelets, 104,000/L; Hb, 9.9 g/dL; LDH, 342 U/L
  • PET/CT shows generalized lymphadenopathy bilaterally in the pleural and pelvic regions; FDG uptake in the liver
  • Liver enzymes, WNL
  • The patient was started on idelalisib 150 mg b.i.d.
  • Follow up imaging at 3 months showed significant regression in the liver and pulmonary nodes and stable disease in the pelvic region
  • After 4 months on therapy she began to experience watery diarrhea, 5 to 6 times per day
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