EJHaem · 2026
Unmasking a Composite Lymphoma: Follicular Lymphoma Emerging After Bispecific Antibody Treatment of Marginal Zone Lymphoma.
СтатьяНазвание и аннотация: Перевод в очереди
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Orosco-Ttamina Angel Luis, Zhou Jiehao, Biondo Juliana, Hossain Farah, Viswanatha David, Greipp Patricia T, Lewis Natasha, Munoz Javier
Аннотация
INTRODUCTION: Composite indolent B-cell lymphomas may remain unrecognized when one component dominates the clinical presentation. Apparent relapse after therapy may, therefore, represent the emergence of a biologically distinct lymphoma rather than the recurrence of the original disease.
CASE PRESENTATION: An 82-year-old woman presented with systemic low-grade B-cell lymphoma that was most consistent with marginal zone lymphoma (MZL). Staging demonstrated peripheral blood involvement and multifocal FDG-avid disease. Treatment with the CD20×CD3-bispecific antibody mosunetuzumab resulted in complete metabolic remission. During surveillance, a new, isolated cervical lymph node developed despite sustained systemic response. Biopsy revealed follicular lymphoma (Grade 1-2) with a germinal center phenotype and a BCL2 rearrangement, findings discordant with recurrence of MZL. Retrospective review of the original specimen identified in situ follicular neoplasia within the initial biopsy. The disease course was, therefore, reinterpreted as a synchronous composite lymphoma in which treatment of the dominant MZL unmasked a previously clinically silent B-cell neoplasm with follicular lineage. Local radiotherapy achieved remission of the follicular component.
CONCLUSIONS: New disease following treatment of an indolent lymphoma should not automatically be interpreted as relapse. Discordant clinical behavior, particularly focal progression after systemic response, warrants repeat biopsy and integrated pathologic reassessment. This case illustrates how therapy may reveal preexisting clonal heterogeneity and emphasizes the importance of temporality in distinguishing relapse from composite lymphoma.
TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.
CASE PRESENTATION: An 82-year-old woman presented with systemic low-grade B-cell lymphoma that was most consistent with marginal zone lymphoma (MZL). Staging demonstrated peripheral blood involvement and multifocal FDG-avid disease. Treatment with the CD20×CD3-bispecific antibody mosunetuzumab resulted in complete metabolic remission. During surveillance, a new, isolated cervical lymph node developed despite sustained systemic response. Biopsy revealed follicular lymphoma (Grade 1-2) with a germinal center phenotype and a BCL2 rearrangement, findings discordant with recurrence of MZL. Retrospective review of the original specimen identified in situ follicular neoplasia within the initial biopsy. The disease course was, therefore, reinterpreted as a synchronous composite lymphoma in which treatment of the dominant MZL unmasked a previously clinically silent B-cell neoplasm with follicular lineage. Local radiotherapy achieved remission of the follicular component.
CONCLUSIONS: New disease following treatment of an indolent lymphoma should not automatically be interpreted as relapse. Discordant clinical behavior, particularly focal progression after systemic response, warrants repeat biopsy and integrated pathologic reassessment. This case illustrates how therapy may reveal preexisting clonal heterogeneity and emphasizes the importance of temporality in distinguishing relapse from composite lymphoma.
TRIAL REGISTRATION: The authors have confirmed clinical trial registration is not needed for this submission.