Skill Checkup: A 74-Year-Old Woman With a History of Treated Diffuse Large B-Cell Lymphoma Has Fatigue and Splenomegaly

Zachary Cohn, MD


March 30, 2023

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 74-year-old woman in the United States with a history of diffuse large B-cell lymphoma (DLBCL) presents with fatigue, loss of appetite, axillary lymphadenopathy, and splenomegaly. She has hypertension and chronic obstructive pulmonary disease (COPD). Her performance status is 2.

Two years ago, she was diagnosed with stage III DLBCL of the nongerminal center B cell–like (GCB) subtype; it was determined that she was at intermediate risk. A fluorescence in situ hybridization (FISH) panel indicated t(14;18) with a BCL2 rearrangement.

She was treated with standard therapy consisting of six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin [hydroxydaunomycin] vincristine [oncovin], prednisone) chemotherapy and achieved a complete remission (CR). She progressed 1 year later. On the basis of her age and comorbidities, it was determined that she was ineligible for autologous stem cell transplantation. She was treated with a chemotherapy-free regimen consisting of an anti-CD19 monoclonal antibody (tafasitamab) and immunomodulator (lenalidomide). She achieved a CR on this regimen.

She now presents 1 year later with a clinical presentation suggestive of disease progression, and repeat biopsy confirms relapse of DLBCL. Her hemoglobin  level is 9.5 g/dL and her serum lactate dehydrogenase level is slightly elevated at 280 U/L. All other laboratory values are within the normal range and there is no evidence of organ dysfunction. She is negative for hepatitis B and hepatitis C. Her performance status is 2.


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