Journal of Chronic Disease Prevention and Care
Open AccessDelayed CNS Relapse in Diffuse Large B-Cell Lymphoma: Insights into Diagnosis, Management, and Therapeutic Challenges in an Elderly Patient
Authors: Gursimran Singh, Shazia Ansari, Khadga Raj Aran.
Abstract
Non-Hodgkin Lymphoma (NHL) is a heterogeneous group of neoplasms and B-cell-derived (B-NHL) comprises approximately 80% of all NHL in adults. There are differences in B-NHL's appearance, clinical features, prognosis, and response to treatment. This case report involved a 72-year-old male with Non-Germinal Centre B-cell-like (NonGCB) diffuse large B-cell lymphoma (DLBCL) who had a good response to six cycles of Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (R-CHOP) chemotherapy and consolidative radiotherapy. Six years later he developed a delayed Central Nervous System (CNS) relapse with neurological symptoms and a hypermetabolic lesion in the right frontoparietal area. Immunohistochemistry (IHC) revealed aggressive profile: CD20, PAX-5, Bcl-6, MUM1 and elevated Ki-67 proliferation rate. CNS-directed therapy, including rituximab, corticosteroids, radiotherapy, and supportive measures, stabilized the disease but highlighted treatment challenges in elderly patients, such as toxicity and organ function decline. This case underscores the need for long-term monitoring, individualized therapeutic approaches, and advancements in CNS-targeted therapies for high-risk DLBCL patients.
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