Case Report of a Relapse of Mantle Cell Lymphoma on Patient with Chronic Infection with Covid-19
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Abstract
Background: Mantle cell lymphoma (MCL) is a distinct subtype of Non-Hodgkin Lymphoma (NHL), it affects 5 to 8% of NHL, it is a clinically heterogeneous disease occurring within a heterogeneous patient population. The median age at time of diagnosis is over 65 years old. The incidence increased with age, and also affects man more than women with ratio of 3 to 1. Overall survivor is different according to subtype of lymphoma. Most patients present at advanced stage, and 30% present in leukemic phase.
Case report: We report a case of 60-year-old women with relapsed mantle cell lymphoma. The patient had no medical past history. The diagnosis of mantle cell lymphoma was made in 2019 revealed by anemic syndrome, the morphological and histological study of lymph node and bone marrow biopsy confirmed the mantle cell lymphoma with expression of CD19+, CD20+, CD5+, CD23-, Cyclin D1+, and KI 67 at 60%. The PET Scan showed FDG-avid disease, the laboratory studies remarques for high level of LDH, elevated B2 microglobulin. The patient underwent R-DHAP regimen (Rituximab, Aracytine, Cisplatin, prednisone) and achieved complete remission after 2 curses, the PET Scan was negative, and the bone marrow biopsy was normal, the collect of hematopoietic stem cell was performed, and the patients received 2 other courses of RDHAP regimen. She does not benefit from autologous hematopoietic stem cell transplant (HSCT) because of severe infection of COVID19. In reality, patient had a server pneumoniae with chronic fever, she was admitted for intravenous antibiotics, all biological exam showed a high level of C- reactive protein, and high level of d-dimers, but no sign of relapse was found. The patient still febrile during 6 months. Autologous hematopoietic stem cell transplant was not realized, but she received maintenance treatment with Rituximab. One year later, the patient developed a mass under the knee with deep deterioration of general condition, relapse was suspected, the surgical biopsy was performed and histological study confirmed the relapse of mantle cell lymphoma. The aim of this case report is to describe the difficulties to manage mantle cell lymphoma associated to covid 19 infection and report the consequences of therapeutic decision.
Conclusion: Not all mantle cell lymphoma is the same, it is crucial to identify patients appropriate for aggressive treatment, autologous hematopoietic stem cell transplant improves event free survival with unclear benefit in all patients, maintenance Rituximab improves overall survivor. Minimal residual disease may guide future therapeutic decisions and help physicians manage these patients. Our patient does not receive autologous hematopoietic stem cell transplant and suffers from chronic Covid19 infection. This association is complicated for the physician and the difficulties of access to targeted therapy in our country limits the therapeutic proposals for patients in relapse.
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