Gilles Salles, MD: Hello, my name is Dr Gilles Salle. I’m a physician at the Memorial Sloan Kettering Cancer Center in New York, United States, and today I will discuss a 74-year-old patient who has been recently diagnosed with diffuse large B-cell lymphoma.
As I mentioned, this 74-year-old patient came to the clinic with a fever presenting for a couple of weeks. He had lost about 14 pounds, unintentionally, and had occasional chest pain in the axillary region. The previous medical history was diabetes mellitus, which was medically controlled, and on physical examination, he looked quite tired—this was the weight loss and a fever of a couple of weeks. He also had obvious palpable bilateral cervical lymph nodes that were not that big.
We started the clinical work-up of this patient. The LDH [lactate dehydrogenase] levels were elevated about 2-fold from normal values, hemoglobin level was slightly diminished to 10.8 g/dL, but everything was within normal range, and there was a slight elevation of creatinine value. Besides that, the other laboratory tests were within normal range.
The serological tests for hepatitis B and C, as well as HIV, were negative. The lymph node biopsy confirmed the large cells, which were CD20-positive, confirming the diagnosis of diffuse large B-cell lymphoma. Complementary examination with immunohistochemistry showed CD10-positive and CD19-positive on the report.
The patient went for a whole-body PET [positron emission tomography]-CT [computed tomography], and as a result, this exam showed activity on the cervical lymph node regions. The largest node was not big, about 2.5 cm, but he had evidence in other areas, such as the axillary region and thorax. He had some subcutaneous tissue involvement, which, because they were distant from the initial localization, classified this patient as stage IV. The performance status was 1, but this was a patient over 60 years old, with inoperable stage IV disease and elevated LDH, so he is in the high-risk category of patients.
What was decided for this patient was rather standard. The patient underwent immunochemotherapy with rituximab and CHOP [cyclophosphamide, doxorubicin, vincristine, and prednisone] and it was well tolerated. He went through 4 cycles. The physician had the impression that the lymph nodes had not fully disappeared after 4 cycles, so an additional PET was prescribed after the 4 cycles. Unfortunately, what was seen on this new PET-CT was progression of disease. Given the age and the comorbidities, and the wish of the patient, the patient was deemed transplant ineligible, and the physician’s decision was to start this patient with tafasitamab and lenalidomide.
Transcript edited for clarity.
Case: A 74-Year-Old Man with Diffuse Large B-Cell Lymphoma
Initial Presentation
Clinical Work-up
Treatment
Peers Discuss Role of Pola-R-CHP vs R-CHOP in Newly Diagnosed DLBCL
April 19th 2024During a Case-Based Roundtable® event, Haifaa Abdulhaq, MD discussed with participants whether the POLARIX trial influences their choice to use the pola-R-CHP as opposed to R-CHOP regimen for patients with newly diagnosed diffuse large B-cell lymphoma.
Read More
Glofitamab Plus Chemo Improves Survival vs Rituximab in R/R DLBCL
April 16th 2024The phase 3 STARGLO trial met its primary end point, improving overall survival in patients with relapsed/refractory diffuse large B-cell lymphoma with glofitamab and chemotherapy vs rituximab and chemotherapy.
Read More
Comparing Results with Loncastuximab in the Clinic and Real-World Settings in DLBCL
April 1st 2024During a Case-Based Roundtable® event, Emily Ayers, MD, discussed the long-term results with loncastuximab in patients with diffuse large B-cell lymphoma and how this drug fared in the real-world setting in the second article of a 2-part series.
Read More
Fitting Loncastuximab Into the Current Landscape of R/R DLBCL
March 21st 2024During a Case-Based Roundtable® event, Emily Ayers, MD, discussed the current landscape for the treatment of patients with diffuse large B-cell lymphoma, the need for better risk stratification data, and what led to the approval of loncastuximab tesirine in the first article of a 2-part series.
Read More