After treatment with bortezomib the patient
is well for 9 months. Subsequently, however,
he develops increasing lymphadenopathy and
progressive fatigue. He is then started on lenalidomide 25 mg orally daily for 21 out of 28
days. He experiences significant fatigue with lenalidomide and prolonged neutropenia requiring dose delays, despite dose modification to
10 mg orally daily. He requires discontinuation
of lenalidomide. Given persistent disease, the
patient then begins treatment with ibrutinib.
Within a few days of starting ibrutinib therapy,
he experiences a marked but transient leukocytosis. Two months later, the patient’s palpable
lymphadenopathy has decreased, and his anemia and thrombocytopenia related to MCL are
improving. He has tolerated treatment well. His
course has been complicated only by a mild,
pruritic maculopapular eruption on his chest,
back, and arms, that was responsive to topical
low-dose steroids. He remains on ibrutinib 1
Advances in our understanding of MCL treatment are revolutionizing the approach to this
once deadly disease. Over the next several years,
these gains will weave themselves into the current treatment paradigm and likely alter the
treatment landscape for MCL as we know it.
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