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Durable remission with Bruton’s tyrosine kinase inhibitor therapy in a patient with leptomeningeal disease secondary to relapsed mantle cell lymphoma
  1. Binoy Yohannan1,
  2. Arthi Sridhar2,
  3. Nghia Nguyen3 and
  4. Adan Rios1
  1. 1Hematology and Oncology, The University of Texas McGovern Medical School, Houston, Texas, USA
  2. 2Department of Internal Medicine, Division of Hematology and Oncology, University of Texas McGovern Medical School, Houston, Texas, USA
  3. 3Pathology and Laboratory Medicine, University of Texas McGovern Medical School, Houston, Texas, USA
  1. Correspondence to Dr Arthi Sridhar; artshri{at}gmail.com

Abstract

Mantle cell lymphoma (MCL) is an incurable B cell non-Hodgkin's lymphoma with a variable clinical course. Central nervous system (CNS) involvement is a rare and dreaded complication in MCL. We report a case of leptomeningeal relapse of MCL that was successfully treated with a single-agent Bruton’s tyrosine kinase inhibitor. A man in his 50s with MCL was treated with six cycles of bendamustine–rituximab, achieving a complete remission (CR) and was subsequently placed on rituximab maintenance for 2 years. Four years later, he was hospitalised with symptoms of organic brain syndrome. Brain MRI and cerebrospinal fluid analysis confirmed CNS relapse of MCL. He was treated with dexamethasone, ibrutinib 560 mg/day and intrathecal cytarabine with improvement in neurological symptoms, and a follow-up MRI showed CR. The patient was later switched to acalabrutinib due to intolerance to ibrutinib. The patient is tolerating this regimen well, remaining in CR 3 years later.

  • Cranial nerves
  • Cancer intervention
  • Neurology (drugs and medicines)
  • Malignant and Benign haematology
  • Neuroimaging

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Footnotes

  • Contributors BY was responsible for conception, design, literature review and drafting of the manuscript. AS was responsible for literature review and data collection and critically reviewed the manuscript for intellectual content. NN reviewed pathology slides and reviewed the manuscript for intellectual content. AR revised the manuscript for important intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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