Transcript 0930 Karena Maher case study

Mantle Cell Lymphoma

6% of Non Hodgkins Lymphomas

Median age 60-70 yrs

More common in males (75%-80%)

Most patients present with stage III/IV disease







64 yr Old Man (Harry *)
Originally from Holland
Lives alone
Divorced
No children
Works as a furniture maker (self employed)
Lives 2 hours from the hospital










Hodgkins lymphoma – Stage III B (2009) classical HD
mixed cellularity
ABVD X 6 Cycles
-- IDDM - smoker 40-50 /day
Mantle Cell Lymphoma – Stage IV B (2013)
- Hypertension/Early COPD
BR X 6
Skin toxicity – GR 3 NCI Toxicity scoring
Difficulty with venous access
Portacath inserted post cycle 2
Good response to therapy











Hodgkins lymphoma – Stage III B (2009) classical HD mixed
cellularity sub type
ABVD X 6 Cycles
-- IDDM - smoker 40-50 /day
Mantle Cell Lymphoma – Stage IV B (2013)
(Neck mass infiltrating the thyroid )
PMHX- Hypertension/Early COPD /IDDM
BR X 6
Skin toxicity – GR 2
Difficulty with venous access
Portacath inserted post cycle 2
Good response to therapy on CT imaging




Relapsed Jan 2014 – Right cervical mass
Nordic protocol x 4
- cardiac toxicity – decreased EF
Good response to therapy on CT imaging
Relapsed Feb 2015 – Right tonsillar mass
Compassionate access programme
Ibrutinib





-
Poor social support
Not working
Difficulty with travelling to hospital
Wants to donate body to science
Multiple medical co morbidities
Cardiac disease
Diabetes
COPD
Smoker
hypothryoidism
Libido issues
THOROUGH MEDICATION
RECONCILIATION












Glucophage 500mg BD
Farxiga 10mg OD
Diamicron MR 120mg od
Rosuvastatin 20mg od
Aspirin 75mg od
Januvia 100mg od
Eltroxin 175mcg od
Cymbalta 60mg od
Telfast 180mg
Mirtazipine 30mg od
Bisoprolol 1.25mcg od
Actrapid PRN
CARDIAC
INVESTIGATIONS


ECG
ECHO

Commenced Ibrutinib Feb 2015

50% Reduction in tonsillar node in March 2015

Continues on full dose 560mg OD

Continues to have a good clinical response

No palpable disease

Haematologically stable

Drug interaction check

Ensure compliance – 560mg OD

On Hitech scheme since August

Bleeding risk

Cardiac arrythmias