Abstracts
PO10
Polatuzumab Vedotin + R-mini-CHP Regimen in an 82-Year-Old Male with Dual-Expressor Primary Extranodal Diffuse Large B-Cell Lymphoma of the Femur
Introduction/Background/Significance: Primary Bone Lymphoma is a rare disease that accounts to approximately 1% of lymphomas and 3-7% of all primary bone tumors. The presentation is usually in the 5th to 7th decades of life, and its presentation at the age of 82 is considered rare. The POLARIX trial redefined the management of DLBCL however patients over 80 years old were excluded from this study. The ongoing Phase III POLAR BEAR evaluates a dose attenuated version for patients on this age group. A dual expressor, defined as the co-expression of MYC and BCL2 protein is a powerful predictor of an inferior survival in DLBCL, whether extranodal or nodal.
Materials and Methods/Case Presentation/Objective: An 82 year old male presented with a closed, complete fracture of the right leg. He underwent partial hip arthroplasty and a biopsy was done which was positive for the following stains: CD20, Ki-67 60-70%, CD79a, BCL6, MUM1, cMYC, BCL2. A PET scan was done which only showed lesions at the right proximal femur. He was then managed as a case of Primary B-cell lymphoma of the right femur stage IE. He was given 2 cycles of POLA-R-mini-CHP. An interim PET scan revealed a persistent metabolic activity (Deauville 5) along with lesions on the ribs indicates an incomplete metabolic response. A repeat biopsy was done which showed a similar profile. He was given localized radiation. On repeat SCAN post radiation, PET scan still showed the same hypermetabolic status but this time now showed structural orthopedic recovery, showing a robust callus formation. He has now recovered from being unable to ambulate, to ambulate without any assistance.
Results/Description/Main Outcome Measure(s): The management of Primary Bone Lymphoma in a patient above 80 years old is a therapeutic challenge. The patient underwent 2 cycles of Polatuzumab R-mini-CHP regimen. The interim scan, showed persistent hypermetabolic lesions, and thus the treatment was augmented further with localized radiation. Despite, the radiographic findings, the patient showed remarkable clinical improvement, from being bed ridden to ambulation without assistance. The repeat scans post treatment and radiation showed a robust callus formation and improved structural bone integrity despite persistence of hypermetabolic lesions.
Conclusion(s).: Although age is a factor for deciding what treatment to give for the patient, molecular risk stratificataion should be considered. We utizilized POLA-R-mini-CHP based on the ongoing POLAR-BEAR trial which targets a population within our patient's age. However, based on the outcome of the patient's PET scan its efficacy to Primary Bone Lymphoma is yet to be determined, and this resport can serve as a guide in dealing with this subtypes. It is also good to know that in dealing with geriatric patient, it is also imperative to also look at the clinical status and quality of life rather than the radiologic findings as a basis for outcome of treatment.
Trademarked Items:
References:
Materials and Methods/Case Presentation/Objective: An 82 year old male presented with a closed, complete fracture of the right leg. He underwent partial hip arthroplasty and a biopsy was done which was positive for the following stains: CD20, Ki-67 60-70%, CD79a, BCL6, MUM1, cMYC, BCL2. A PET scan was done which only showed lesions at the right proximal femur. He was then managed as a case of Primary B-cell lymphoma of the right femur stage IE. He was given 2 cycles of POLA-R-mini-CHP. An interim PET scan revealed a persistent metabolic activity (Deauville 5) along with lesions on the ribs indicates an incomplete metabolic response. A repeat biopsy was done which showed a similar profile. He was given localized radiation. On repeat SCAN post radiation, PET scan still showed the same hypermetabolic status but this time now showed structural orthopedic recovery, showing a robust callus formation. He has now recovered from being unable to ambulate, to ambulate without any assistance.
Results/Description/Main Outcome Measure(s): The management of Primary Bone Lymphoma in a patient above 80 years old is a therapeutic challenge. The patient underwent 2 cycles of Polatuzumab R-mini-CHP regimen. The interim scan, showed persistent hypermetabolic lesions, and thus the treatment was augmented further with localized radiation. Despite, the radiographic findings, the patient showed remarkable clinical improvement, from being bed ridden to ambulation without assistance. The repeat scans post treatment and radiation showed a robust callus formation and improved structural bone integrity despite persistence of hypermetabolic lesions.
Conclusion(s).: Although age is a factor for deciding what treatment to give for the patient, molecular risk stratificataion should be considered. We utizilized POLA-R-mini-CHP based on the ongoing POLAR-BEAR trial which targets a population within our patient's age. However, based on the outcome of the patient's PET scan its efficacy to Primary Bone Lymphoma is yet to be determined, and this resport can serve as a guide in dealing with this subtypes. It is also good to know that in dealing with geriatric patient, it is also imperative to also look at the clinical status and quality of life rather than the radiologic findings as a basis for outcome of treatment.
Trademarked Items:
References:
