Brief Answer:
I would recommend the following sir.

Detailed Answer:
Dear sir,
I did review your concern and all the latest reports that you have uploaded.
Certainly your follicular lymphoma that was stage 1 has now progressed. The major concern right now is the lymphnode in supraclavicular region and the one that is pressing the right kdiney probably and causing slight derangements in renal function.

The good thing is that your bone marrow although shows involved by PET scans is functioning fine and LDH is not raised. These are good prognostic signs.

However, i would recommend that at present stage you would require chemotherapy.
First of all I would recommend, to discuss with your doctor if they can get a complete excision biopsy of the supraclavicular lymphnode that had the higest SUV(they might have gotten very small piece of it as the reporting pathologist commented on the quantity of tissue). IT would give us a better picture of your current disease status and exactly determine your grade.
At bear minimum you would rightly require a Bendamustin plus Rituximab therapy, but if the total biopsy of that lymphnode shows transformation or large areas of grade 3a-3B then may be RCHOP or REPOCH therapy which is a higher regimen. Obviously it is more effective but also has more toxicity as compared to Bendamustin plus Rituximab which is relatively less toxic.

Now to answer your questions one by one-
1)Chemotherapy is quite reliable as thousands of patients use it and it is very useful in improving survival especially rituximab as it is a targetting agent that kills B cell lymphomas by binding to CD20 a receptor on surface of B cells.
2)Whether you will get cured or not is a very difficult question to answer sir as every human responds differently to chemotherapy. But we have seen people who live years after receiving chemotherapy for 3-6 months and then followed up just on Rituximab.
3) yes your age is not that old and you will I believe tolerate the chemotherapy better considering your blood counts and LDH is normal and do not have any symptoms. So that increases the chances of your survival definately.

I believe your lymphoma is at a stage where it is a matter of caution and concern but not unnecessary worry. I believe that with right diagnosis and proper chemotherapy and post chemo care you will do fine. And we can all hope for the best. Generally follicular lymphomas are indolent and slow growing lymphomas and I have seen many patients survive without much morbidity for years, living a normal life and i wish the same for you too.

So all in all,
your care has been fine till now and your current status does require chemotherapy.
The only added recommendation from my part would be a complete excision biopsy of the supraclavicular lymph node with highest SUV to grade the lymphoma and catch signs of transformation, if any and start the right chemotherapeutic agent from beginning.
If it is the present grade of 2A with few 3A areas then I believe Rituximab and Bendamustine is the right combination as advised by your doctor.

I hope this helps. I want you not to take any stress and live your life positively and in the right spirit. Take everyday as a challenge and I am sure you will come out of every difficulty with smile and grace sir.

Let me know if you have any more questions or concerns.
wish you all the best sir.
Sincerely,
Dr Parth Desai.

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Brief Answer:
Hello sir, i did not get your detailed reply

Detailed Answer:
Hello sir,
I hope you have received my opinion to your questions.
I have not yet received your reply in detail.

Awaiting for your reply sir.
Let me know if you have any more questions or concerns.
wish you all the best sir.
Sincerely,
Dr Parth Desai.

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Brief Answer:
Hi please contact customer support or attach your query in a word file

Detailed Answer:
Hi Sorry for this delay in services.
I would recommend you to contact customer support or also attach your query to
YYYY@YYYY with Sub: ATTN 'Dr Parth XXXXXXX Desai'.

I hope this helps
waiting for your reply sir.
Wish you all the best sir
sincerely,
Dr Parth Desai

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Brief Answer:
Be positive and you will do really good.

Detailed Answer:
Hello sir,
thank you for your reply query.
I am quite confident that you will do good with chemotherapy.
We should hope for the best and be positive and like your spirit.
Stress is a natural phenomenon with anyone who has illness and you are a brave person dealing with this illness and with great courage.
Keep yourself fit and healthy with good diet and exercise and take the medications as prescribed by your doctor and you will do well.

Wish you all the best sir.
Thank you for choosing healthcaremagic.
Sincerely,
Dr Parth Desai.

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