Perforated Small Intestinal Diffuse Large B-Cell Lymphoma Successfully Managed With Surgical Resection and Staged Introduction of Polatuzumab Vedotin-Based Chemotherapy

Polatuzumab vedotin in combination with rituximab, cyclophosphamide, doxorubicin, and prednisone (Pola-R-CHP) is a vincristine-free regimen recently approved for untreated diffuse large B-cell lymphoma (DLBCL). However, its safety in the early postoperative setting remains unclear. We report a case of primary intestinal DLBCL with suspected perforation managed with surgical resection followed by staged introduction of Pola-R-CHP. Rituximab was started on postoperative day 11, followed by CHP on day 15 as the first cycle of R-CHP. Pola was added from cycle 2. The patient showed an initial tumor reduction without serious gastrointestinal (GI) toxicity. This case suggests that staged introduction of Pola-R-CHP may minimize postoperative GI risk while maintaining safety.