CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
MYC-Positive Follicular Lymphoma Complicated by Refractory Lactate and Clonal Evolution: a case report
Provisionally accepted
- First Affiliated Hospital of Harbin Medical University, Harbin, China
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Follicular lymphoma (FL) typically follows an indolent clinical course, however, a subset of patients develops an aggressive and treatment refractory phenotype. Here we report a fatal case of a 46-year-old male with FL grade 3A characterized by recurrent severe tumor-associated lactic acidosis (>15 mmol/L) and rapid therapeutic failure. The patient presented with B symptoms, extensive lymphadenopathy, profound hyperlactatemia, and serum IgM-κ monoclonal protein. Immunohistochemistry confirmed FL grade 3A diagnosis and revealed MYC protein overexpression within 4months, manifesting new nodal lesions, markedly elevated lactate levels, sustained MYC overexpression, and emergence of both IgG-κ and IgM-κ monoclonal proteins, a serological signature of ongoing clonal evolution. Subsequent treatments (R-CHOP, R-CDOP, BR, and G-EPOCH) over 6 months failed to achieve durable disease control. The clinical course was dominated by refractory, recurrent type B lactic acidosis that correlated directly with tumor activity. The patient ultimately died of fulminant lactic acidosis complicated by tumor lysis syndrome, 7 months after initial diagnosis. This case identifies an ultra-aggressive variant of FL defined by MYC-driven metabolic dysregulation and dynamic clonal evolution, underscoring the need for early recognition and development of novel therapeutic strategies targeting metabolic reprogramming.
Keywords: chemoresistance, Clonal Evolution, follicular lymphoma, Lactic acidosis, metabolic reprogramming, Myc protein
Received: 06 Jan 2026; Accepted: 11 Feb 2026.
Copyright: © 2026 Wang, Wang, Yu, Yang, Li, Wang, Liu, Meng and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Shu-Ye Wang
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