If the patient achieves a partial response with aggressive induction chemotherapy, the most appropriate of the listed options for second-line therapy according to the NCCN guidelines would be a regimen containing a BTK inhibitor (ie, acalabrutinib, ibrutinib, and zanubrutinib). BTK is a pivotal protein for B-cell tumorigenesis. If a BTK inhibitor is contraindicated, combination therapy with an immunomodulator and an anti-CD20 antibody is recommended by the NCCN guidelines.
Although HDT/ASCR was the eventual plan intended for this patient following aggressive induction therapy, this option should be reserved for patients who were able to achieve complete response with front-line therapy. Second-line therapy should be considered in order to help the patient achieve complete response.
Editor's Note: Skill Checkups are wholly fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.
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Cite this: Ann S. LaCasce. Skill Checkup: A 62-Year-Old Man With Lumps on His Neck and Under His Arm - Medscape - May 25, 2023.