Diffuse Large B-Cell Lymphoma
Presentation:
A 28 year old male presented to his general practitioner for increasing
abdominal pain over the past two months and early satiety. The patient’s
past medical history was notable for HIV and hepatitis B, diagnosed in 2008
after a routine blood test. A CT scan of the abdomen and pelvis showed
multiple soft tissue masses and lymphadenopathy. The largest masses were in
the right abdomen (4.7 x 7.9cm) and right inguinal canal (4.9 x 5.7cm). The
patient was referred to a hematologist and was admitted to a
hematology/oncology unit as a scheduled admission for an expedited work up
of diffuse large B cell lymphoma.
Diagnosis
The patient was diagnosed with HIV-associated diffuse large B cell lymphoma
after a biopsy of the tumor. This is an aggressive, fast growing cancer of
the B-lymphocytes. A bone marrow biopsy was done to detect whether the
cancer had spread to the patient’s marrow; the results were negative.
Additionally, the patient presented with a creatinine of 1.7. A MAG3 renal
scan showed partial obstruction of his right ureter, which impaired the
right renal function to 33%. The patient then had a stent placed in his
right ureter to improve function.
Treatment
Patient started chemotherapy during his admission to begin treatment of the
DLBCL. He first had a mediport placed. Patient is currently receiving
R-EPOCH chemotherapy in combination with Neulasta® growth factor post
chemotherapy. The Neulasta® stimulates neutrophil recovery and helps to
reduce the risk of infection. Due to the patient’s increased creatinine
levels, impaired kidney function and high tumor burden, he received
rasburicase prior to starting chemotherapy. This helps to reduce the risk
of tumor lysis syndrome and the buildup of uric acid in the kidneys. He
will also continue his current HIV and hepatitis B medications (Truvada®,
ritonavir and entecavir).
Outcome
The patient was discharged home after his first cycle is completed. Other
than some mild nausea due to chemotherapy, his assessment is benign and he
appears to be tolerating the chemo well. The patient will continue with
R-EPOCH for several cycles in order to induce remission. This type of
lymphoma has a 50-80% cure rate depending on stage at diagnosis and
comorbidities.