Gastrolab / Science Source
This patient's clinical presentation and endoscopy findings are consistent with a diagnosis of recurrent MCL presenting as a colonic mass.
MCL is an aggressive type of non-Hodgkin lymphoma that accounts for approximately 5%-7% of all lymphomas. Nearly 80% of patients have extranodal involvement at initial presentation, occurring in sites such as the bone marrow, spleen, Waldeyer ring, and the gastrointestinal (GI) tract. Secondary GI involvement in MCL (involving nodal and/or other extranodal tissue) is common and may be detected at diagnosis and/or relapse. In several retrospective studies, the prevalence of secondary GI involvement in MCL ranged from 15% to 30%. However, in later studies, routine endoscopies in patients with untreated MCL showed GI involvement in up to 90% of patients, despite most patients not reporting GI symptoms.
The colon is the most commonly involved GI site; however, both the upper and lower GI tract from the stomach to the colon can be involved. Lymphomatous polyposis is the most common endoscopic presentation of MCL, but polyp, mass, or even normal-appearing mucosa may also be seen.
New and emerging treatment options are helping to improve survival in patients with relapsed/refractory MCL. According to National Comprehensive Cancer Network guidelines, the preferred second-line and subsequent regimens are:
• Bruton tyrosine kinase (BTK) inhibitors:
o Acalabrutinib
o Ibrutinib ± rituximab
o Zanubrutinib
• Lenalidomide + rituximab (if BTK inhibitor is contraindicated)
Other regimens that may be useful in certain circumstances are:
• Bendamustine + rituximab (if not previously given)
• Bendamustine + rituximab + cytarabine (RBAC500) (if not previously given)
• Bortezomib ± rituximab
• RDHA (rituximab, dexamethasone, cytarabine) + platinum (carboplatin, cisplatin, or oxaliplatin) (if not previously given)
• GemOx (gemcitabine, oxaliplatin) + rituximab
• Ibrutinib, lenalidomide, rituximab (category 2B)
• Ibrutinib + venetoclax
• Venetoclax, lenalidomide, rituximab (category 2B)
• Venetoclax ± rituximab
Brexucabtagene autoleucel is suggested as third-line therapy, after chemoimmunotherapy and treatment with a BTK inhibitor.
Timothy J. Voorhees, MD, MSCR, Assistant Professor of Internal Medicine - Clinical, Division of Hematology, The Ohio State University James Comprehensive Cancer Center, Columbus, OH.
Timothy J. Voorhees, MD, MSCR, has disclosed the following relevant financial relationships:
Received research grant from: AstraZeneca; Morphosys; Incyte; Recordati.
Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.