Here’s how readers responded to a You Make the Call question about treatment of low-grade B-cell lymphoma with high-risk cytogenetics.
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This may be immune mediated. I would favor the use of single agent rituximab first. Since the patient is strongly CD20 positive, it may be a marginal zone lymphoma.
Christian Schultheis, MD
Des Moines, IA
Ibrutinib would be an option, although in marginal zone lymphomas its efficacy is not so great. Also, MYD88 was wild type.
I would probably try rituximab plus low-dose oral cyclophosphamide (100 mg per day for 21 days). If the patients gets better, one could repeat these cycles.
Andreas Neubauer, MD
This is probably a case of Binet stage lll B-cell chronic lymphocytic leukemia in an asymptomatic patient in need of treatment with steroids and allopurinol.
Mohammad Salem, MD
Medina, Saudi Arabia