Title : Histologic transformation of mantle zone lymphoma to diffuse large B-Cell lymphoma: A case report of disease relapse after Covid-19 infection
Introduction: Mantle cell lymphoma is a rare subtype of non-Hodgkin’s lymphoma, which may develop into other subtypes, such as diffuse large B-cell lymphoma, which is the most common among all non-Hodgkin's lymphomas. Usual clinical features of diffuse large B-cell lymphoma include quickly growing, non-painful mass, enlarged lymph nodes in the neck, groin and/or abdomen, fever, night sweats, weight loss. Current data of COVID-19 infection risk and outcome in patients with nonHodgkin's lymphoma, receiving chemotherapy and immunosuppression treatment, is variable and insufficient. We report a case of histologically confirmed transformation of mantle zone lymphoma to diffuse large B-cell lymphoma, the disease relapse after COVID-19 infection.
Case description: We present a 58-year-old female patient, who had a history of abdominal pain episodes associated with fever, diarrhea and nausea in 2017. Biopsy of colon revealed mantle cell lymphoma. Patient received polychemotherapy courses with Rituximab, Cyclophosphamide, Vincristine, high dose Cytarabine and Cisplatin. In the 2020 disease relapsed. Therapy with Rituximab and Bendamustine was continued. In 2021 disease relapsed again and lymphoma’s transformation to diffuse large B-cell lymphoma was histologically confirmed. After the high dose chemotherapy (Rituximab, high dose Cytarabine and Cisplatin), autologous stem cell transplantation was performed. The Moderna vaccine against COVID-19 was received twice. Positron emission tomography showed complete metabolic remission. 6 months prior to case presentation diffuse large B-cell lymphoma has relapsed after COVID-19 infection, which was diagnosed in February 2022. The patient received Remdesivir antiviral therapy, followed by specific therapy courses with Rituximab, Bendamustine and Polatuzumab. COVID-19 infection returned in July 2022. Lymphoma dynamic was negative. Chemotherapy was changed to Vinblastine, Cyclophosphamide and Bleomycin – with a positive effect. Overall patient condition at present is dynamically positive.
Conclusions: In this report, we show a patient with diffuse large B-cell lymphoma setback after COVID-19 infection. Even after antiviral therapy COVID-19 patients with hematologic malignancies may have prolonged active infection with impaired viral excretion.
Summary: Current study demonstrates a case of multiple lymphoma relapses with following chemotherapy courses, COVID-19 infection setbacks after vaccine due to intense immunosuppression
Keywords: Mantle cell lymphoma, diffuse large B-cell lymphoma, COVID-19, chemotherapy.