CASE STUDY Mantle Cell Lymphoma MANTLE CELL LYMPHOMA

MANTLE CELL LYMPHOMA � 6% of Non Hodgkins Lymphomas � Median age 60 -70

Case � � � � 64 yr Old Man (Harry *) Originally from Holland

Past Medical History � � � � � Hodgkins lymphoma – Stage III B

Past Medical History � � � Hodgkins lymphoma – Stage III B (2009) classical

� � Relapsed Jan 2014 – Right cervical mass Nordic protocol x 4 -

ISSUES � � � - Poor social support Not working Difficulty with travelling to

Medications THOROUGH MEDICATION RECONCILIATION � � � Glucophage 500 mg BD Farxiga 10 mg

Case Study � Commenced Ibrutinib Feb 2015 � 50% Reduction in tonsillar node in

Take home Points � Drug interaction check � Ensure compliance – 560 mg OD

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CASE STUDY Mantle Cell Lymphoma

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

Case � � � � 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

Past Medical History � � � � � 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

Past Medical History � � � 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

ISSUES � � � - 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

Medications THOROUGH MEDICATION RECONCILIATION � � � Glucophage 500 mg BD Farxiga 10 mg OD Diamicron MR 120 mg od Rosuvastatin 20 mg od Aspirin 75 mg od Januvia 100 mg od Eltroxin 175 mcg od Cymbalta 60 mg od Telfast 180 mg Mirtazipine 30 mg od Bisoprolol 1. 25 mcg od Actrapid PRN CARDIAC INVESTIGATIONS � � ECG ECHO

IBRUTINIB

Case Study � Commenced Ibrutinib Feb 2015 � 50% Reduction in tonsillar node in March 2015 � Continues on full dose 560 mg OD � Continues to have a good clinical response � No palpable disease � Haematologically stable

Take home Points � Drug interaction check � Ensure compliance – 560 mg OD � On Hitech scheme since August � Bleeding risk � Cardiac arrythmias