Site Editor
Jeremy S. Abramson, MD, MMSc
Jeremy S. Abramson, MD, MMSc
Posted: Tuesday, January 21, 2025
Although there have been advances in the treatment of mantle cell lymphoma (MCL), other innovative therapies are still being developed. André Fortin, MD, of the Hôpital de l’Enfant-Jésus, Centre Hospitalier Universitaire de Québec-Université Laval, and colleagues presented a novel case of MCL treated with the Bruton’s tyrosine kinase (BTK) inhibitor zanubrutinib and radiotherapy, which was published in the journal Cureus.
A 76-year-old female with MCL presented with a metastatic lesion in the parotid gland that developed from previously treated spinocellular carcinoma. She presented with anemia and progressive leukocytosis after being asymptomatic for 8 years and was therefore initiated on bendamustine and rituximab. Progressive leukocytosis and significant, widespread adenopathies were identified on imaging 4 years later, which prompted treatment with zanubrutinib.
The patient tolerated zanubrutinib well, and further imaging demonstrated a significant reduction in lymph node involvement; however, a new parotid mass was identified. She underwent a parotidectomy, which revealed a trifocal epidermoid carcinoma and perineural invasion. The patient was referred for adjuvant radiotherapy, with 68.8 Gy directed at the hypermetabolic focus and 60 Gy to the gland over 32 fractions; zanubrutinib was continued.
The patient did not require dose adjustments during radiotherapy, and the combination was reported to be well tolerated; adverse events included grade 1 radiation dermatitis and grade 2 radiation-induced mucositis. The mucositis was cleared in a short time, whereas the radiation dermatitis did not resolve until 3 months after treatment; neither condition progressed. Toward the end of treatment, the patient developed transient grade 2 lymphopenia, which partially resolved. Grade 3 progressive neutropenia was diagnosed after completing treatment but was resolved within weeks.
Progression of MCL was not reported on subsequent PET imaging, and the patient did not experience infectious symptoms or fever. She presented with disease recurrence approximately 3 months after treatment completion. The patient was referred to the palliative care unit for pain management, and she remains on zanubrutinib with no signs of MCL recurrence.
Disclosure: The study authors reported no conflicts of interest.
JNCCN Spotlights
