Part 4: Indolent B-Cell Non-Hodgkin Lymphoma
Robert Frank Cornell, MD
Hematology/Oncology Fellow, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
Timothy S. Fenske, MD
Associate Professor of Medicine, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
A 56-year-old man presents with abdominal pain, fatigue, and night sweats. Prior to this presentation he was otherwise healthy. White blood cell (WBC) count is 1900 cells/ÁL, hemoglobin is 9.2 g/dL, and platelet count is 42,000/ÁL. Examination reveals massive splenomegaly. Computed tomography (CT) scan confirms splenomegaly and reveals no significant lymphadenopathy. Peripheral blood lymphocytes exhibit villous projections. A bone marrow biopsy and aspirate exhibits a 12% population of neoplastic small B-lymphocytes positive for CD20 and CD79a and negative for CD5, CD10, CD23, CD25, and CD103. Cytogenetic studies demonstrate deletion of 7q32. Which of the following is the most appropriate treatment?