May 3, 2019


Case:A 70-Year-Old Man With Follicular Lymphoma

H & P:

  • A 70-year-old man presents with night sweats and general fatigue
  • PMH: hypertension, no history of MACE
  • PE: Groin is tender to touch, no tenderness in abdomen
  • Initially diagnosed with bilateral axillary contiguous stage II FL 5.5 years ago
    • Grade 2 FL, 4 masses (each >3 cm)
    • FLIPI status: high risk

Current biopsy and labs:

  • Biopsy: grade 2 FL without transformation
  • ECOG performance status: 1
  • Hematologic results
    • ANL: 1200 /µL
    • Platelets: 105,000 /µL
    • Hemoglobin: 11.9 g/dL
  • LDH: 335 U/L
  • eGFR: 75 mL/min/1.732
  • Imaging: PET/CT reveals inguinal lymphadenopathy, with largest mass 8.5 cm

Treatment and disease history

  • Front-line BR
    • Completed 6 cycles, achieved PR by 3 months
    • Maintained PR for 20 months before developing fever and mediastinal lymphadenopahty
  • Second-line R-CHOP
    • Competed 6 cycles, achieved PR at 3 months
    • PR maintained for 5 months
    • Time since completion of last treatment: 5 months

Current treatment

  • Started on single-agent idelalisib 150 mg twice a day