CHSU Discovery

Abstract

Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most prevalent aggressive non-Hodgkin lymphoma, typically managed with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), boasting a 60% cure rate. Pola-R-CHP, a modification substituting vincristine with polatuzumab-vedotin (Polivy), has emerged as a potential advancement, particularly with the recent FDA approval of Polivy in April 2023.

Case Report: A 70-year-old male with a past medical history of hypothyroidism was diagnosed with stage 3 DLBCL, manifesting as a solid mass in the left lateral mesentery measuring 8 x 8.6 x 9 cm. Histopathological analysis revealed DLBCL with positive BLC2 expression and negative BLC6 and MYC. Following surgical excision of the mass, the patient underwent 6 cycles of Pola-R-CHP adjuvant therapy. Subsequent PET scan showed diminished hypermetabolic activity, indicating a favorable response to treatment.

Discussion: Polatuzumab-vedotin, an antibody-drug conjugate targeting CD79b on malignant B-cells, facilitates apoptosis through the release of anti-mitotic monomethyl auristatin E (MMAE). Studies indicate that Pola-RCHP regimen offers superior outcomes in terms of disease progression, relapse, or mortality compared to standard R-CHOP therapy. In this case, the patient achieved complete radiographic response after 4 months of Pola-RCHP therapy, with the treatment regimen concluding with Rituximab monotherapy. This case underscores the promising efficacy of polatuzumab in advanced stage 3 DLBCL, highlighting its potential as a valuable addition to DLBCL treatment protocols.