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A 61-year-old female patient was diagnosed with mantle cell lymphoma, stage IV, with bone marrow involvement and nodal involvement.
The KI67 value was 35% at diagnosis. No TP53 mutation was detected. The transplant was deferred due to patient preferences. The patient was initially treated with R-maxiCHOP alternating with HDARAC followed by rituximab maintenance. A relapse occurred two years into rituximab maintenance. There was nodal progression, symptomatic but there was still no TP53 mutation.
The patient was treated with ibrutinib 560 mg daily, but the dose was reduced to 420 mg due to constant Grade 2 GI toxicity and finger pain. Complete remission on therapy was observed after 6 months. 3 years into ibrutinib treatment, the patient started to get recurring upper airway infections, with multiple courses of antibiotics. Their IgG levels were measured to be normal and PET/CT data suggest continuous remission of MCL.
