Suggest Treatment For Recurrent Lymphoma

Posted on Sat, 16 Aug 2014

Question: Greetings
I was diagnosed with Diffused Large B Cell Lymphoma in 2013 February. I went through the following treatments:

(1) 6 cycles of CHOP-R and in addition they gave 3 doses of methotroxate chemo (March 2013)
(2) ICE, BEAM followed by Stem Cell Transplant (November 2013)
(3) 20 doses of Radiation. (March 2014)

Latest CT scan report as of XXXXXXX 15 2014 is shown below.
According to my hematologists they have nothing more to do and I have less than one year to live!
I would very much appreciate if anyone could suggest any new drug therapy or alternative therapy that could save my life
-------------------------------------------------------------CT scan report on XXXXXXX 16 2014-----------------------------
ABDOMEN AND PELVIS:
HEPATOBILIARY SYSTEM:
Liver: Unremarkable
Gallbladder / ducts: Unremarkable
Pancreas: Unremarkable
GASTROINTESTINAL TRACT: Colonic and duodenal diverticulosis.
GENITOURINARY SYSTEM:
Adrenals: Bilateral new adrenal masses as follows:
1. Right, image 22:14 mm
2. Left, image 19:50 mm
Kidneys / Ureters: Bilateral new renal masses as follows:
1. Right, image 34:22 mm
2. Left, image 22:21 mm
Urinary Bladder: Unremarkable
Prostate : Unremarkable
LYMPHATIC SYSTEM:
Spleen: Unremarkable
Lymph nodes: Residual but improved lymphadenopathy. Comparison is made
to diagnostic CT from January 8, 2014. The conglomerate retroperitoneal
index node on image 35 measures 30 x 57 mm (prior 52 x 75 mm) V 171" (9 0
PERITONEUM, RETROPERITONEUM & MESENTERY: There is a small amount of free
fluid. There is a new retroperitoneal/perinephric mass, on image 34
measuring 39 mm.
VESSELS & OTHER: Unremarkable
BONES / BODY WALL: Unremarkable
IMPRESSION:
1. Mixed response in the abdomen. There are bilateral new adrenal and renal
masses as well as a new left perinephric mass, most likely progressive
lymphoma. However, the pre-existing retroperitoneal lymphoma demonstrates
some improvement.
2. No convincing thoracic lymphoma. The right upper lobe groundglass
pulmonary nodule is stable compared to the most recent study. Recommend
continued followup.
3. Left thyroid nodule or cyst. Recommend evaluation with ultrasound.
--------------------------------------------------------------

Answered by Dr. dr. Jawahar Ticku (12 hours later)

Brief Answer:
Recurrent lymphoma

Detailed Answer:
Dear XXXX
You have undergone extensive treatment for this disease, In spite of Chemotherapy, radiotherapy, stem cell transplant thee disease is progressing. This is unfortunate. Normally this lympho proliferative disorder melts after chemotherapy or Radiotherapy. Even after stem cell transplant which involves prior high doses of chemotherapy to exclude even the last surviving cell, I feel the regime R CHOP was not appropriate and could have been discontinued after three cycles after assessing the response.
I hope luckily there is no bone marrow involvement and has not converted into leukemia.
After making the evaluation I personally feel that you need to undergo targeted chemotherapy and again Radiation therapy to the residual masses. You Oncologist will choose the same appropriately.
I am sure you will be benefited with this management.
Truly,
Dr. J. ticku

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Above answer was peer-reviewed by : Dr. Prasad