Timeline of my experience with Primary Mediastinal Large B Cell Lymphoma

Remission status: ACHIEVED ✅️

July 2020 (11cm Tumor) vs February 2022 (No evidence of disease)
“Courtney your scans look really great and we can say you’re in remission”

Here is my Doctors notes of my entire beginning to ending. If you’re like me and love medical stuff, then this is for you. If not that’s totally okay too. I just wanted to share this as a reality that recovery and remission is possible over time. This was a very slow process but I’m so happy to reach the beginning of the end 💞 In order to reach total remission I need to go 5 years after my last chemotherapy. But I’ve already completed 1 year so far! So with that let’s keep going 🙌 It’s so exciting to read the progess collected, as each visit closer to remission.

A never ending amount of pet scans, 2 biopsys, 6 rounds of chemotherapy (40+ days in the hospital), a bone marrow biopsy, a medi port placed in my chest, so much blood work, the dehydration, so many medications I don’t even know how I kept up with the 10+ pills at day/night, accidental addiction to the pain medication, the countless days of nausea and vomiting, the 45 pound weight loss, losing all my hair, losing my friends, and so many other events took place. I am so proud to be here today. 🥳

Patient Name: Courtney Leonard
Date: 2/28/2022
Referring Physician: Dr. Rizwan Danish
Identification: Courtney Leonard is a 24 y.o. previously healthy female diagnosed in 7/2020
with PMBCL, treated with EPOCH-R x4, 1 cycle of RCHOP and 1 cycle of HyperCVAD with
Deauville 4 EOT scans, presenting for review of PET/CT scans.


Oncologic History:
– 2/2020: Noted cough and headaches.
– 5/24/2020: Noted chest and back pain x 7 days.
– 6/18/2020: Presented to the ER with SOB and headaches. CXR and subsequent CT scan
showed large mediastinal mass.
– 6/18/2020 CT chest with contrast: 10.3 x 6.7 x 8.0 cm anterior mediastinal mass with
central necrosis. No pericardial effusion. 5 mm RLL pulmonary nodule.
– 7/9/2020 mediastinal core needle biopsy: partially fibrotic tissue infiltrated by an atypical
lymphoid infiltrate – medium size lymphoid cells with areas of alveolar fibrosis. ICH: CD20+,
BCL6+, MUM1+, CD30+, negative for CD10, CD5 and BCL2. Ki67 70%. Morphologic and
immunophenotypically consistent with primary mediastinal B cell lymphoma.
– Recommended to start DA-EPOCHR with ppx acyclovir, bactrim and allopurinol. Per patient,
MUGA normal.
– 7/28/2020: C1 EPOCHR at dose level 1 (Vincristine 0.6 mg, adriamycin 14 mg,
cyclophosphamide 1080 mg, etoposide 72 mg)
– 8/18/2020: C2 EPOCHR at dose level 1
– 9/15/2020: She had significant nausea, pain requiring a 1 week dose delay. C3 EPOCHR at
dose level 1.
– 9/25/2020 PET/CT: Images personally reviewed- overall excellent response to therapy with
small residual mediastinal uptake.

10/20/2020: 2 week delay due to diarrhea requiring IV hydration, vaginal bleeding. C4
EPOCHR at dose level 1.

  • Around 11/17/2020: C5 RCHOP
  • 12/4/2020 PET/CT: Interval decrease in size of a previously described anterior mediastinal
    mass, left component now measures 2.8 (3.8 cm prior) with interval decrease in depicted
    surrounding FDG uptake to background the right retrosternal component size has
    decreased to 2 cm (2.5 cm prior) with interval surrounding FDG uptake disease SUV max 4
    (3.6 previously).
  • 12/28/2020: HyperCVAD. adriamycin 50 mg/m2, vincristine 2mg, cyclophosphamide 300
    mg/m2 q12 hours x3 days. Scheduled for vincristine on 1/8/2020. Per notes, overall plan for
    2-3 cycles of chemotherapy followed by possible autoSCT.
  • 1/7/2021: Initial clinic visit at which time recommendation for no further chemotherapy,
    proceed with EOT scans and possible RT if residual disease pending final PET/CT.
  • 1/29/2021 PET/CT: images personally reviewed and discussed with radiology. Current L
    component of the mass measures 3.2 x 2.2 (previously 3.4 x 2.4) with SUV 3.9; R
    component measures 2.0 x 1.4 (2.1 x 1.5 previously) with SUV 4.0. Size and FDG uptake of
    lesions are very similar to 12/2020 Pet scan findings. Liver SUV uptake is 2.0.
  • 2/8/2021 PET/CT showed small residual uptake slightly above liver (Deauville 4) and
    recommendation for continue monitoring with PET in 2 months.
  • 4/6/2021 PET/CT: Continued decrease in size and metabolic activity of the anterior
    mediastinal lymph nodes (SUV 3.4) measuring 2.9 x 1.7 cm and 1.6 x 1.0 cm on the R. SUV
    of hepatic parenchyma is 1.9. Consistent with Deauville 4.
  • 6/3/2021 Core need biopsy of mediastinal mass: predominantly necrotic tissue, focal area
    of histocytes and rare lymphocytes. Flow attempted but too few lymphocytes for
    characterization.
  • 8/10/2021 PET/CT: Slight interval decrease in size (1.9 versus 2.5 cm) previously depicted
    rim calcified anterior mediastinal soft tissue density, interval decrease in size and FDG
    uptake to background (SUV max 1.8) in a previously depicted anterior mediastinal lymph
    node and interval appearance of mildly FDG avid (SUV max 3.7) anterior
    mediastinal/prevascular soft tissue density- likely reflecting a thymic remnant and a stable
    appearing, 0.4 cm, right lower lobe pulmonary nodule
    Interval History:
  • LCV 8/23/2021 at which time plan for repeat PET or CT in 6 months for ongoing follow up.
    She had ongoing back pain and was still on opiates.
  • No chest pain, no night sweats. No new lymphadenopathy that she has noted.
  • No cough or SOB
  • Back pain is now resolved. She had an addiction to norco and fentanyl- now since
    being off has had no further pain.
  • Noah is doing well, he is turning 3

2/15/2022 Pet/CT: mediastinal SUV 1.4; hepatic parenchyma 1.8. R anterior mediastinal
lymph node decreased in size and metabolic activity with SUV 2.5. no other FDG avid
lymphadenopathy.

Assessment/Plan:
Courtney Leonard is a 24 y.o. female diagnosed in 7/2020 with PMBCL s/p 6 cycles of
chemo immunotherapy with Deaville 4 EOT PET/CT and repeat biopsy without
refractory/residual disease. She has been monitored with serial imaging since that time with
continued decrease in size and SUV of mediastinal mass/nodes.
Today, we reviewed her most recent Pet from 2/2022 that continues to show decreasing
SUV of the mediastinal nodes. We discussed that given it has been 1 year since her last
treatment this is unlikely to be any residual disease and I would recommend continue
observation. While her SUV is still slightly above liver, it has continue to decrease and thus
she is likely in remission at this time. I am so happy to see that she is now off all opiates
without any residual pain. She is back at school and her functional status has normalized. I
am happy to continue to be involved with her care however she would prefer.
# PMBCL: in remission based on most recent imaging
– Reviewed most recent scan showing NED. Recommend no further scans at this time, only
if new symptoms develop.
– has port removal scheduled for 3/9/2022.
– She will continue to follow locally with Dr. Danish for surveillance. I am happy to see her on
an as needed basis in the future- she would like to see me in 6 months -will arrange VV with
no labs prior
# Back pain: now resolved and off opiates
– encouraged her to remain off opiates
Yasmin H Karimi, MD
Clinical Assistant Professor
University of Michigan
Rogel Cancer Center

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