CASE STUDIES
Recurring Lymphoma Case Study
Patient History
An 87 year old male presented to a Urologist with an elevated PSA of 23.3. Urology evaluation followed with a biopsy that showed adenocarcinoma of the prostate. During treatment for prostate cancer, a CT of his abdomen/pelvis showed 5 cm of right pleural effusion. Oncology evaluation was obtained and a CT chest showed diffuse adenopathy with a monotypic lymphocytic population present in the pleural fluid at the time of thoracentesis with IGG restricted staining. A PET scan then showed hypermetabolic area diffuse lymph nodes and a biopsy resulted in inguinal lymph node (LN) enlargement – showing marginal zone vs diffuse large B-cell Lymphoma.
Treatment Plan
The patient received 6 cycles R-CHOP treatment and a follow up EF – 25 % was noted with recurrent pleural effusions, which was resolved when complex cardiology treatment was started. PET/CT follow up was obtained showing increasing cervical, retropectoral/subclavian and axillary LN enlargement. Disease progression was concluded, as SUV at those sites ranged from 2.8 to 21.3. A biopsy of the right subclavian LN showed CDS B-cell Non-Hodgkin lymphoma (NHL).
The patient was then referred to TOI and FNA right axillary LN confirmed progression with no evidence of transformation. We recommended and moved forward with a Rituxan + Zydelig combination treatment and the patient tolerated the dosage well. Eventually he was prescribed Venclexta with a gradually increased dosage and also tolerated it well.
Results
A recent PET scan disclosed re-staging in the setting of his diffuse large B-cell lymphoma with recurrence as follicular lymphoma. Some apparent activity in left mandible, which was possibly dental in origin. Asymmetry was identified in the right mandible/tongue, as compared to the left SUV 5.0 correlation with dental examination recommended. Some activity was identified of the right mid and lower lung, most likely inflammatory. The patient will complete 15 months of treatment and continue PET/CT scan surveillance as recommended. The left external iliac adenopathy is smaller with decreased FOG activity when compared with PET scan from the previous year. Overall, we are seeing great results and look forward to continuing his care and treatment.
This patient was provided our oncologist’s personal cell phone number for close monitoring and access. The patient was encouraged to reach out anytime he needed counseling and comfort, no matter the time of day. On one occasion, patient transportation did not show to pick up him after his appointment so a TOI staff member gave him a ride home. The patient was very complementary of the personal attention given to him by our provider and staff. We treated his main disease, along with other additional health issues, which has helped him maintain a good quality of life.
