Article

From B to T: a Case of Concurrent B-Cell and T-Cell Lymphomas Successfully Palliated With Targeted Therapies


 

Background

Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive type of non- Hodgkin lymphoma (NHL), comprising 30% of all NHL. Due to a decreased state of immunosurveillance resulting from the disease itself and its associated therapies, patients are at increased risk of developing a secondary malignancy. Multiple primary malignancies have been reported to occur in up to 15% of patients with DLBCL, retrospectively.

Herein, we review a case of a man with DLBCL who concomitantly developed ALK negative anaplastic large cell lymphoma (ALCL) distinctly of T-cell lineage who was successfully treated with palliative therapy for both diagnoses despite his advanced age and diagnosis associated with a poor prognosis with continued effect and sustained quality of life.

Case Report

An 88-year-old man presented with stage III DLBCL, diagnosed in 12/2018, was deemed not to be an aggressive therapy candidate. As such, he was treated with Rituximab monotherapy for 6 cycles, ending in 02/2019, with remarkably good effect. He remained in a PR with stable disease on serial PET/CTs until 09/2021, at which time he was noted to have Horner’s Syndrome in clinic. CT chest demonstrated a right apical lung mass, not previously seen on prior scans measuring 4.2 x 2.7 cm. Other sites of nodal disease remained stable on PET/CT.

Biopsy of the lesion revealed CD30+ ALK-negative ALCL with distinct T-cell marker positivity on immunohistochemistry and the absence of B-cell lineage markers. After discussion at our treatment planning conference, we decided to treat with brentuximab-vedotin (Bv) monotherapy for 6 cycles. End of treatment PET/CT demonstrated a PR with near resolution in background PET avidity at the lesion. His symptoms of Horner syndrome also improved.

Conclusion

A diagnosis of aggressive lymphoma increases the risk of developing a secondary malignancy and providers should remain vigilant of this. Elderly individuals in whom aggressive therapies may be precluded can still greatly benefit from palliative targeted therapy even in the setting of diseases historically associated with a poor prognosis.

Recommended Reading

Filling opioid prescriptions akin to a Sisyphean task
Federal Practitioner
Ways to lessen toxic effects of chemo in older adults
Federal Practitioner
Few new cancer drugs replace current standards of care
Federal Practitioner
Dodging potholes from cancer care to hospice transitions
Federal Practitioner
Improved cancer survival in states with ACA Medicaid expansion
Federal Practitioner
Patients with blood cancers underutilize palliative care
Federal Practitioner
Quality of life benefit exaggerated in some cancer studies
Federal Practitioner
Nodular Sclerosing Hodgkin Lymphoma With Paraneoplastic Cerebellar Degeneration
Federal Practitioner
A Rare Case of HHV8+ Multicentric Castleman Disease Presenting as Dermatitis
Federal Practitioner
Evaluating the Incidence of Febrile Neutropenia and the Appropriate Use of Prophylactic Granulocyte Colony Stimulating Factors in Veterans Who Received Treatment for Non- Hodgkin’s Lymphoma
Federal Practitioner