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
After discussion with the patient, the decision is made for observation alone. Two years after initial treatment, she develops new-onset night sweats, low-grade fevers, and profound fatigue. She also complains of abdominal pain. Physical exam reveals a palpable suprapubic mass. Positron emission tomography (PET)/CT shows a large pelvic mass measuring 8.6 × 4.2 cm, with high FDG uptake (maximum standard uptake value of 22). No other sites of adenopathy are seen. Lactate dehydrogenase is elevated. Bone marrow biopsy and aspirate demonstrate normal trilineage hematopoiesis. What is the next most appropriate step?