Dr. Beebee, an 80 year old pediatrician, presented to Dr. Nagourney's office with extensive lymphadenopathy. Lymph node and bone marrow biopsies established mantle cell lymphoma with over 40% marrow infiltration.
The PET/CT confirmed stage 4 mantle cell lymphoma with large volume retroperitoneal disease.
Hoping to avoid excessive toxicity for an 80 year old patient, we conducted our functional profile to explore treatment options.
The results were highly gratifying.
In addition to activity for Bortezomib, the patient had a very favorable profile for Bendamustine.
With our laboratory results in hand, we suggested the relatively mild combination of Rituxan plus Bendamustine.
This combination which was found active in the patient's tissue culture had been reported by a German group to provide good results when compared with R-CHOP.
After three cycles of treatment, there was much improvement. After six cycles still more. The question then became: Should we change to an alternative treatment?
After conferring with a consultant, we opted to complete eight total cycles and then moved to maintenance Rituxan.
With three months additional follow up (off Bendamustine) the recent PET-CT was entirely normal. All parameters had normalized.
Soon to be 81, the patient continues to practice medicine and maintains an extremely active lifestyle throughout his entire treatment.
He was able to receive a simple combination that provided durable benefit but very little toxicity.
Our initial concern was that we might be undertreating him, but this was put to rest by the functional profile that gave us the confidence to use this comparatively mild combination.
Even with a diagnosis as grave as mantle cell lymphoma stage 4, this patient was not too old to be cured.