Clinical Update

Challenging Case Of Paediatric B-NHL at SRMS IMS

Master Azad 12 years old male.


Paediatric B cell – NHL (stage-III )


Successful management of a challenging case of Paediatric NHL

Case Summary

Master Azad 12 years old male presented to pediatric deptt (at SRMSIMS Bareilly) in very critical condition in January 2019 with c/o pain and swelling abdomen, breathlessness. On clinical examination, there was massive ascites,b/I pleural effusion. After workup (Biopsy from renal mass with IHC,PET CT whole body and other relevant investigations) he was diagnosed as stage III B -NHL ( CD-20 positive). The case was discussed in tumor board and decided to be treated with chemotherapy as per Inter-B-NHL ritux 2010 protocol (Prephase- COP; 1 course / induction-R-COPADM; 2 courses/consolidation- R-CYM ; 2 courses ).

Finally treatment was started on 7/2/2019 with COP regimen. After COP regimen (pre-phase) there was so many complications encountered due to tumor lysis and severe pancytopenia which was managed successfully with intensive care in PICU. On 19th February 1st induction chemotherapy (RCOPADM) was administered. On 8th March 2019, all the blood reports come normal and there was almost complete response of the disease. Now he is continued for further courses of chemotherapy under the supervision of the multidisciplinary team.

Treatment given: Chemotherapy (intrathecal / intravenous),PICU care, high end antibiotics, multiple blood transfusions, ICD drainage, ascitis drainage tube and other supportive therapies.

Advice from coped: Each case of malignancy should be discussed in tumor board for proper management.