A 51-Year-Old Woman with Diffuse Large B-Cell Lymphoma - Episode 2

The Challenges of Disease Management in R/R DLBCL

An oncologist describes the typical major challenges of managing patients with R/R DLBCL and the incidence of relapsed or refractory disease.

Case: A 51-Year-Old Woman with Diffuse Large B-Cell Lymphoma (DLBCL)

Case Description

A 51-year-old woman presented with fatigue and back pain that worsened in the past 3 months

History of mild hypertension (controlled with medication)

Physical exam: Left posterior cervical node, 1.7-cm; left anterior cervical node, 2.9-cm; right supraclavicular node, 2.5-cm

ECOG PS 0

CT scan: multiple enlarged mesenteric and retroperitoneal nodes, largest measuring 5.3 x 3.1 cm

Biopsy confirmed diffuse large B-cell lymphoma, IHC positive for:

CD20

BCL-6, MUM1

BCL-2 (50% of cells)

MYC (>90% of cells)

Ki67 83%

FISH: negative for MYC rearrangement/chromosomal abnormality

Normal CBC and LDH

Initial Treatment

Patient received 6 cycles of RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)

Back pain and fatigue resolved

Post-treatment PET scan results demonstrated a CR (Deauville score 2)

Patient was scheduled for follow-up visits at 3-month intervals

Follow-up Notes/Labs 9 Months After Completion of First-Line Therapy

Patient complained of increased fatigue and back pain, emergent fever and night sweats

A palpable lymph node in right groin was discovered on physical examination

PET and CT scans: new left inguinal lymph node, increase in size of residual node, as well as multiple metabolically active lesions in lymph nodes of the retroperitoneum, abdomen, and pelvis

Biopsy: DLBCL, non-germinal center B-cell

Second-Line Treatment

Patient was referred to transplant center

Patient received salvage RICE (rituximab, ifosfamide, carboplatin, etoposide)

PET-CT scan results after 2 cycles: Deauville score 5

Third-Line Treatment

When discussing next steps, the patient declined ASCT and CAR T-cell therapy due to the time commitment and travel required for administration, as well as financial concerns

The patient received polatuzumab vedotin/bendamustine/rituximab as 3rd-line treatment