Monoclonal Anti-CD 20 Antibody Used in Non-Hodgkin's Lymphoma: A Case Study

Katrina S Malone; Thomas B Wiggers; Libby M Spence

doi:10.29074/ascls.17.4.197

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Katrina S Malone
1. is a Clinical Laboratory Scientist at the University of Mississippi Medical Center in Jackson, MS, and a former student of the Clinical Laboratory Sciences program at the University
Thomas B Wiggers, MS CLSpH(NCA)⇑
1. is an Associate Professor of Clinical Laboratory Sciences, and faculty mentor for this student paper
Libby M Spence, PhD CLS (NCA)
1. is Professor at the University of Mississippi Medical Center in Jackson MS

Address for correspondence: Thomas B Wiggers MS CLSpH(NCA), The University of Mississippi Medical Center, Department of Clinical Laboratory Sciences, School of Health Related Professions, 2500 N State Street, Jackson MS 39216. (601) 984-6322. twiggers{at}bellsouth.net

Extract

A 26-year old gentleman with a history of peptic ulcer disease was admitted in March of 2001 with a two-month history of abdominal pain and a 13 pound weight loss. CT of the abdomen showed a 6 cm x 7 cm pelvic mass and a second 6 cm x 7 cm periaortic mass in the post-hepatic area. The patient underwent exploratory laparotomy and pathology was consistent with diffuse, large-cell lymphoma with immunoblastic features. The operative report and the surgeon described an intra-abdominal cavity consisting of multiple bulky lymphadenopathy in the retroperitoneum, involving the small bowel. Flow cytometry showed a monoclonal population of cells positive for CD19, CD20, and HLA-DR. The patient underwent six cycles of chemotherapy that included Rituxan®. After three cycles of chemotherapy, he had complete resolution of the pelvic and periaortic masses. He still had residual tumor in the post-hepatic area, 5 cm x 6 cm in size. He received three more cycles of chemotherapy with Rituxan® and CT scans were repeated. The CT neck, chest, and pelvis scans were negative; however the post-hepatic mass remained.

MEDICAL HISTORY: Otherwise unremarkable.

LABORATORY FINDINGS: See Table 1.

Immunophenotypic analysis revealed a monoclonal B lymphoid population characterized as CD19+, CD20+, CD5-, CD10+/-, CD23-/+, FM C7-/+, HLA-DR+, and restricted to kappa light chain immunoglobulin with intermediate intensity (Table 1). DNA content analysis of all cells showed a diploid pattern with an increased proliferative rate. The common morphologic features of a B-cell lymphoma are the large cell size, usually four to five times…

ABBREVIATIONS: CD = cluster designation antigen; CHOP = cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy; CT = computed axial tomography; NCI = National Cancer Institute; NHL = non-Hodgkin's lymphoma.