Case Study: Successful Treatment of Primary Mediastinal Large B-Cell Lymphoma (PMBCL) in a Transgender Patient

Introduction

Primary Mediastinal Large B-Cell Lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma (DLBCL) that is more common in women than men. However, a case study published in Internal Medicine describes the successful treatment of a male-to-female transgender patient with PMBCL who opted out of estrogen preparation after chemotherapy. This article discusses the disparate factors that influenced the treatment decisions made by the team in Japan and provides updates on the latest treatments and research for PMBCL and DLBCL.

Treatment and Diagnosis

The patient, aged 50 years, sought medical attention for cough and dyspnea on effort, along with facial and neck swelling. Radiography followed by biopsy showed a mediastinal tumor and right pleural effusion. The patient was diagnosed with PMBCL, which was characterized by scattered proliferation of small round cells with mild pleomorphism and a background of fibrosis. The physicians employed dose-adjusted EPOCH-rituximab (DA-EPOCH-R) for chemotherapy and achieved complete metabolic remission after the sixth round of therapy, on day 139. The patient avoided upfront radiotherapy and maintained CMR for approximately 1 year after the end of treatment.

Transgender Healthcare Issues

According to the case study, previous studies have reported that overall cancer incidence does not differ markedly between transgender people and cisgender control research participants. Few cases of hormone therapy–induced breast cancer have been reported in transgender patients. This is likely because of the late initiation of estrogen supplementation. However, this patient had no history of smoking, drinking, or asbestos exposure and did not wish to resume estrogen preparation after chemotherapy. The patient struggled with hospitalization, wherein she was the first transgender individual to need a bed and could not afford a private room. The team discussed their thought processes with the patient, and it was ultimately agreed that because she currently “more closely resembled a male than a female,” a room designated for men would be more appropriate. The team stated that after what they hoped was empathetic deliberation, they felt they “ultimately had no choice but to make a judgment based on the patient’s outward appearance.”

Latest Treatments for PMBCL and DLBCL

A meta-analysis study will estimate the global and regional burden of HIV-associated non-Hodgkin lymphoma to aid the development of prevention and control strategies. The 5 agents in ViPOR—including venetoclax and lenalidomide—worked better together in a phase 1b/2 trial than they previously have, individually, in treating patients with certain diffuse large B-cell lymphoma (DLBCL) subtypes. With its recent approvals around the world to treat newly diagnosed and relapsed/refractory diffuse large B-cell lymphoma (DLBCL), the antibody-drug conjugate polatuzumab vedotin is changing regimens for current and future patients, with manageable adverse effects. Catherine Diefenbach, MD, an American Society of Hematology expert and director of the Clinical Lymphoma Program at NYU Langone’s Perlmutter Cancer Center, discussed the evolving state of diffuse large B-cell lymphoma (DLBCL) therapeutics and exciting areas of research.

Conclusion

PMBCL is a rare subtype of DLBCL that requires meticulous treatment planning and management. The case study of a transgender patient with PMBCL provides an opportunity to examine the unique challenges faced by transgender people in healthcare. Researchers and clinicians are continually seeking new therapies and prevention strategies to curb the global burden of non-Hodgkin lymphomas.

Long-tail keywords: Primary Mediastinal Large B-Cell Lymphoma, Diffuse Large B-Cell Lymphoma, Transgender Healthcare, HIV-Associated Non-Hodgkin Lymphoma, Antibody-Drug Conjugate Polatuzumab Vedotin

Originally Post From https://www.ajmc.com/view/da-epoch-rituximab-successfully-treating-pmbcl-in-a-transgender-woman

DA-EPOCH-Rituximab Successfully Treats PMBCL in Transgender Woman