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Lymphoma Clinic: Approaches to the Management of Relapsed/Refractory Follicular Lymphoma and Relapsed/Refractory Diffuse Large B-Cell Lymphoma

  • Authors: Laurie H. Sehn, MD, MPH
  • CME / ABIM MOC Released: 6/30/2023
  • Valid for credit through: 6/30/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for hematology/oncology specialists.

The goal of this activity is for learners to be better able to apply recent data regarding newer therapies for R/R follicular lymphoma and R/R diffuse large B-cell lymphoma to the management of these diseases.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Clinical trial data of new therapies used to treat R/R NHL
  • Have greater competence related to
    • Mitigating treatment-related adverse events in patients with R/R NHL
    • Selecting appropriate treatment for patients with R/R NHL 
  • Demonstrate greater confidence in their ability to
    • Integrate newer therapies into the treatment plans for patients with R/R NHL


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  • Laurie H. Sehn, MD, MPH

    Chair, Lymphoma Tumour Group
    BC Cancer Centre for Lymphoid Cancer
    Clinical Professor of Medicine
    Division of Medical Oncology
    University of British Columbia
    Vancouver, British Columbia, Canada


    Laurie H. Sehn, MD, MPH, has the following relevant financial relationships:
    Consultant or advisor for: AbbVie Inc.; Astrazeneca; BeiGene (Beijing) Co., Ltd; Bristol Myers Squibb Company; Genmab; Incyte Corporation; Janssen Pharmaceuticals; Kite Pharma, Inc./Gilead Sciences, Inc.; Merck & Co., Inc.; Roche/Genentech, Inc.; Seagen Inc.
    Research funding from: Roche; Teva


  • Charlotte Warren

    Senior Director, Content Development, Medscape, LLC 


    Charlotte Warren has no relevant financial relationships.  

  • Tristin Abair, PhD

    Senior Medical Writer, Content Development, Medscape, LLC 


    Tristin Abair, PhD, has no relevant financial relationships.  

Compliance Reviewer

  • Stephanie Corder, ND, RN, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Stephanie Corder, ND, RN, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Lymphoma Clinic: Approaches to the Management of Relapsed/Refractory Follicular Lymphoma and Relapsed/Refractory Diffuse Large B-Cell Lymphoma

Authors: Laurie H. Sehn, MD, MPHFaculty and Disclosures

CME / ABIM MOC Released: 6/30/2023

Valid for credit through: 6/30/2024, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Alice is a 74-year-old retired seamstress who has been married for 48 years and has 2 adult children and 7 grandchildren who live nearby. She is active in her community and helps care for her grandchildren. She has a history of hypertension and moderate arthritis.

Five years ago, Alice was diagnosed with follicular lymphoma (FL) and treated with bendamustine plus obinutuzumab. She achieved a complete response (CR) and did well following completion of therapy. At her 4-year follow-up, positron emission tomography/computed tomography (PET/CT) showed disease progression and she began second-line therapy with lenalidomide plus rituximab. Imaging showed a very good partial response (VGPR). She now comes in 24 months later for routine follow-up and reports moderate swelling in her neck and groin. Her workup is summarized in Table 1.

Table 1. Alice's Workup

Demographics/patient information
  • 74 years old, female
  • Height: 5 ft 2 in; weight: 155 lb
Personal and family medical history
  • History of hypertension and arthritis
  • Hysterectomy at age 58
  • Current medications include lisinopril, ibuprofen for arthritic pain, vitamin D, and a daily multivitamin
  • No family history of cancer
  • Has noted progressive fatigue, no B symptoms
  • ECOG PS: 0
Physical examination
  • Increasing cervical and inguinal lymphadenopathy
  • No palpable splenomegaly or hepatomegaly
  • BP: 125/85 mm Hg; heart rate: 82 bpm
  • WBC count: 7.3 × 109/L
  • RBC count: 4.8 × 1012/L
  • Hemoglobin: 14.1 g/dL
  • Hematocrit: 45%
  • Platelet count: 250 × 109/L
  • Serum LDH: 200 IU/L (ULN 250 IU/L)
  • Creatinine: 0.9 mg/dL
  • Calcium: 9.2 mg/dL
  • FDG-avid lymphadenopathy in cervical nodes and abdomen ranging in size from 1 to 7 cm. SUVs range from 6 to 9
BP, blood pressure; CBC, complete blood count; ECOG PS, Eastern Cooperative Oncology Group performance status; FDG, 18F-fluorodeoxyglucose; IU, international unit; LDH, lactate dehydrogenase; RBC, red blood cell; SUV, standardized uptake value; ULN, upper limit of normal; WBC, white blood cell.
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