Case Discussion: Symptomatic Relapse and Therapy Selection After Bendamustine-Rituximab

Segment V introduces the program’s first clinical case: a patient who initially responded well to bendamustine-rituximab (BR) but now presents with symptomatic relapse, mild cytopenias, abdominal fullness, and B symptoms. This case illustrates a common and clinically challenging scenario, prompting the faculty to walk through their decision-making process. NP Bailey highlights that this patient is clearly beyond the window for watchful waiting and requires treatment intervention. She reviews therapeutic considerations following prior BR exposure, noting that re-treating with bendamustine is less appealing given newer, more effective options and the timing of relapse. The discussion centers on the choice between tafasitamab-R2 and epcoritamab-R2, two newly approved regimens demonstrating strong efficacy in relapsed follicular lymphoma. The faculty compare practical aspects of these therapies, including route of administration (IV vs subcutaneous), step-up dosing requirements, monitoring demands, and feasibility in community vs academic settings. Lenalidomide management again emerges as a key theme, particularly given the patient’s mild cytopenias. The faculty discuss strategies for initiating therapy at a lower dose and titrating as tolerated to maintain both efficacy and quality of life. This case provides a real-world demonstration of how novel bispecific- and CD19-based regimens fit into treatment sequencing and illustrates the importance of individualized therapy based on disease characteristics, patient comorbidities, and logistical considerations.