YO11 - Satisfactory response after Rituximab-Bendamustin in Poor Performance Status Geriatric with Relapsed DLBCL

Case summary

A 67-year-old woman, with a previous history of DLBCL (diffuse large B-cell lymphoma) who had a complete response six years ago after RCHOP, came to the hospital because of a 5 cm lump in the right groin and 13 kg weight loss within a month. Abdominal MSCT with contrast showed multiple nodal metastases thus lymphadenectomy was done, and pathology examination revealed a relapse of DLBCL. Her initial ECOG performance status was 4, in which she could only sit in a wheelchair due to swelling in right leg. Duplex ultrasound of her right lower extremity revealed a partial thrombus in the right femoral vein, and her baseline laboratory results were hemoglobin 12.1 g/dL, leucocytes 2.4x10³/µL, platelets 60x10³/µL, and neutrophil count 1300/µL.

The patient was offered two options for her treatment: general palliative care or chemotherapy with a low toxicity regimen. She chose chemotherapy and was subsequently given RB regimen with Rituximab 375 mg/m² on day 1, Bendamustine 100 mg/m2 on day 1, and 50 mg/m² on day 2. For her DVT, fondaparinux 7.5 mg/24 hours was planned for later following an improvement in platelet counts. After the first cycle, she experienced febrile neutropenia with pneumonia and post-lymphadenectomy abscess. She received filgrastim injection of 300 µg twice a day and meropenem 1 g three times a day.

On the 12th day after the first cycle RB, she experienced dyspnea, peripheral edema, crepitus at the lung bases, and pulmonary edema found on her chest x-ray evaluation. The patient was treated with drip furosemide of 10 mg/hour and fondaparinux treatment was initiated.

On the 13th day, she had melena, a drop in platelets to 53x10³/µL and hemoglobin to 7.5 g/dL. She was given an apheresis platelet and packed red cells transfusion. On the 20th day, she was discharged with ECOG 2.

The second cycle of chemotherapy was given 28 days after the first cycle (Rituximab 375 mg/m2, Bendamustine 50 mg/m2 on day one and two). Seven days later, she came to the outpatient clinic on foot with no edema in sight and ECOG 1.

This case showed that the RB regimen effectively responded to relapsed DLBCL as a second-line and relatively safe. Chemotherapy may be considered in geriatric with poor performance status if the cancer is chemotherapy sensitive.

Clinical trial identification

Editorial acknowledgement