Case 140: Update 4

We now have a report on the bone marrow.

Immunophenotype:
Lambda restricted B cell population = 8.9% of total nucleated cells.
CD19+, CD5 negative, FMC7 variable (+/neg), CD23 variable (neg/+), CD200 variable (weak/neg),
CD20+, CD22+, CD103 negative, CD10 negative, CD45+, CD79b weak, CD38 variable (neg/+),
CD11c negative, CD2 negative, sIg++

Immunohistochemistry:
Trilineage haematopoiesis is reduced and the normal bone marrow architecture is disrupted by
mixed diffuse, nodular and paratrabecular infiltrates of small mononuclear cells. The infiltrate
comprises CD20+/CD79a+/BCL2++small B cells that are negative for BCL6, cyclinD1, CD3, CD5 and
CD10. The heavy, abnormal B cell population represents 80% of the total specimen.

Molecular studies:
Variant MYD88 L265P detected.

You think this lady has CHAD secondary to lymphoplasmacytic lymphoma.
How would you manage her at this point?

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