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Thread: Chemo once in two weeks instead of 3 weeks.Pls help :(

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    Chemo once in two weeks instead of 3 weeks.Pls help :(

    Hi All,

    I am Manoj from India. My father is undergoing treatment for the NHL for past 1.5 months and he has been staged as 1AX. After discussions with the doctors, we started CHOP treatment and completed 2 cycles of it. Unfortunately, as we couldn't arrest the growth of it completely, it started to grew up again before the completion of his prescribed rest period of 21 days, so we now have started R-CHOP. Just a week before we finished his 3rd cycle with R-CHOP. My fathers feels like this drug is working better than the previous one and we are hoping for the best. Our doctor have said that remission from this NHL could be concluded only after his 4 cycles and we are scared about this. Could any one please let me know the remission possibility, being at this stage? Also is it possible to get the tumor again after remission, if remission is possible?


    Also, we are getting Chemo once in two weeks instead of the normal 21 days cycle. Is this a factor to worry about. Pls help

  2. #2
    Administrator Top User Kermica's Avatar
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    manokrrish, Welcome. It is hard to answer your question without knowing the specific type of lymphoma your dad is battling. Do you have that information? It soounds like it is an aggressive type similar to diffuse large b cell (DLBCL) and, if that is the case, R-CHOP ios the gold standard for treatment at this time. Most patients recieve 6 rounds buit given that your Dad had 2 CHOP treatments before the Rituxin was added, he is getting that dose. The question to ask is whether or not the Riuxin will be continued after the chemo is completed.

    Good health,

    kermica
    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 63
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09

    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.

    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.

    Significant progression detected in PET scan - December 2012

    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.

    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.

    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".

    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.

    June 2014 - started 2 year maintenance Rituxin, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.

    Remember the Rules!

  3. #3
    Newbie Top User joepet's Avatar
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    Welcome manokrrish.

    R-CHOP21 (treatment every 21 days) is the most common form of R-CHOP in the world, but there are other countries, most notably Germany, where R-CHOP14 is more popular. I've yet to see a conclusive study that says one is better than the other. On one hand, R-CHOP14 doesn't give a body much chance to recover, so you will most definitely need Neulasta or other form of white blood cell booster to help ward off infection. On the other hand, the treatment finishes that much earlier, and it's possible that the condensed schedule might actually be more effective for the patient.

    After the proposed regimen, you would have six rounds of CHOP and four rounds of Rituxan, after which a full remission is definitely not outside the realm of possibility. Though the decision as to whether or not to continue treatment should be based on results of biopsies/scans and not a timetable set in stone.

    Is your father scheduled to get radiation treatment after the chemo?
    My Story: http://cancerforums.net/viewtopic.php?t=11396
    Diffuse Large B cell Lymphoma
    Stage 1AE (localized in colon)
    Began six cycles of R chop 21 3rd Dec 2008
    Finished R chop 21 Apr 2009
    Complete remission as of May 2009
    Confirmed April 2010

  4. #4
    Administrator Top User Didee's Avatar
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    Hi there.
    Stages one and 2 of my subtype, the standard treatment is CHOP and Radiation.
    My Onc wanted me on CHOP 14 if I could tolerate it. I did.

    We do need more information on the type to be able to offer any help.
    Aussie, age 57
    1987 CIN 111. Cervix lasered, no further problems.

    Dx Peripheral T Cell Lymphoma stage 2B bulky, aggressive Dec/09.
    6 chop14 and Neulasta.
    Clean PET April/10, 18 rads 36gy mop up. All done May 2010
    Iffy scan Nov. 2011.
    Scan Feb 2012 .still in remission.
    Still NED Nov 2012. On to yearly bloods now.

    May/2012. U/sound, thyroid scan, FNB. Benign adenoma. A lump in otherwords, nodule if you wish to be specific.

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    Senior User rizza's Avatar
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    Hi there, I'm pretty sure Dad57's (a member on this forum) son had R-CHOP14. He is now in remission, so hopefully that is some peace of mind for you.

    The way I would look at it is that having the treatment every 14 days, instead of every 21 means that it's all ver quicker and you can get back to normal life!

    Wishing your Dad lots of good luck!
    30yo female (27 at diagnosis)
    Mediastinal Large B-cell Lymphoma
    Started six cycles of R CHOP 21 on 8th Jan 2010, completed 23rd April 2010
    4 weeks of daily radiation, started on 18th May 2010
    First clear PET scan 5th August 2010!
    2 years cancer free June 2012!
    My blog: http://dlbcljourney.blogspot.com/

  6. #6
    Senior User jmarek's Avatar
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    I was also given the option of every two weeks which I was really thinking of taking but after my first week my oncologist recommended every 3 weeks as I was getting side effects that she did not expect me to have until after a couple of treatments. At the very least she said it doesn't take away anything from the treatment. It just lets you move on that much faster, though there is some belief that it may work more efficiently sped up like that. Just don't get discouraged if they change it down the road as that shouldn't make much difference.
    Take care and good luck to you Dad!
    Jeff
    Age 40
    Stage 4 Non-Hodgkin s Large B Cell Lymphoma
    Diagnosed on March 30th 2011/Staged on April 6th

    R-CHOP treatments
    First treatment: April 12th
    Eighth treatment: September 8th
    Have been in Remission since 9/2011

    "Yesterday is history, tomorrow is a mystery, and today is a gift, that's why its called the present"
    Dr. Wayne Dyer

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    Kermica and All,

    Yes my father's type of NHL is Diffuse Large B Cell Lymphoma. Just a day back we gave the 4th cycle of treatment(2nd cycle of R-CHOP). Even this time the tumor got aggressive on the 15th day of the 3rd cycle, and we rushed to the hospital with panic. The tumor was just normal till 14th day. Doctors are also puzzled because of this aggression after just 14 days and they too are thinking for additional drugs with CHOP drugs from the 5th cycle onwards.

    Also we have not yet decided about any radiation after the CHEMO....

  8. #8
    Administrator Top User ChemoMan's Avatar
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    Quote Originally Posted by manokrrish View Post
    Kermica and All,

    Yes my father's type of NHL is Diffuse Large B Cell Lymphoma. Just a day back we gave the 4th cycle of treatment(2nd cycle of R-CHOP). Even this time the tumor got aggressive on the 15th day of the 3rd cycle, and we rushed to the hospital with panic. The tumor was just normal till 14th day. Doctors are also puzzled because of this aggression after just 14 days and they too are thinking for additional drugs with CHOP drugs from the 5th cycle onwards.

    Also we have not yet decided about any radiation after the CHEMO....
    Hello

    Try not to panic. It can take time for improvement to be seen. if you don't mind me asking where is the 'tumor' it may help in framing our responses to you.

    You may want to read the 3 rules in my Signature at the bottom of this post. They come in handy when things are not going as well as expected.
    Age 57
    Diffuse Large B cell Lymphoma
    Stage 2a
    Finished six cycles of R chop 21 26th May 2008
    Officially in remission 9th July 2008
    Remission reconfirmed 1st October 2008
    Remission reconfirmed 17th June 2009
    Remission reconfirmed 7th June 2010
    Remission reconfirmed 6th July 2011
    NED on the 2/01/2013
    No more scheduled visits to the Prof
    http://cancerforums.net/viewtopic.php?t=9620

    RULE NUMBER 1.....Don't Panic
    RULE NUMBER 2..... Don't forget rule Number 1

    Great moments often catch us unaware-beautifully wrapped in what others may consider a small one.

    I may not have gone where I intended to go,
    but I think I have ended up where I needed to be.

  9. #9
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    Hi Manoj,

    I too am from India (Hyderabad) and had undergone Six rounds of R Chop for treatment of DLBCL. I was in stage IV when I was diagnosed and in a Coma hence could not discuss much about my disease and the options for treatment. When I opened my eyes I was told that I am suffering from Cancer and that I need to be treated by R-chop. The first cycle was given within two days and from then on it was every 14 days.

    I cannot offer any advice on the options but can get some advice from the oncologist who treated me. He is one of the best in the city and always has time to discuss cases and offer advice.

    Take care and all the best for your Dad.
    Age : 44
    Diffuse Large B cell Lymphoma
    Stage 4
    Finished Six cycles of R Chop 14 - 21st Jan '09
    Officially in remission 9th February 2009
    Remission confirmed 24th April 2009

    http://cancerforums.net/viewtopic.ph...ghlight=#49797

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    ChemoMan,

    Sure, I am trying not to get panic for the best. My dad's tumour is at Groin.

    Badri,

    I am from Tamil Nadu. So from the discussions I could get better confidence that the 14 days cycle wont make the situation worse, still I have a doubt, if it is normal to get the tumor(DLBCL) aggressive after the prescribed days of cycle?(we are facing this nowadays).

    Also, the tumor seemed to be slow responsive to the medicine for the first 3 cycles. Can we expect a better response in the current and later cycles?

  11. #11
    Administrator Top User ChemoMan's Avatar
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    Hi manokrrish

    Your fathers situation sounds similar to a long time member, SingleDad. he had a 'tumor' very close to his testicles in his groin. You can read his story here:

    http://www.cancerforums.net/threads/...ll=1#post43801

    Good luck
    Age 57
    Diffuse Large B cell Lymphoma
    Stage 2a
    Finished six cycles of R chop 21 26th May 2008
    Officially in remission 9th July 2008
    Remission reconfirmed 1st October 2008
    Remission reconfirmed 17th June 2009
    Remission reconfirmed 7th June 2010
    Remission reconfirmed 6th July 2011
    NED on the 2/01/2013
    No more scheduled visits to the Prof
    http://cancerforums.net/viewtopic.php?t=9620

    RULE NUMBER 1.....Don't Panic
    RULE NUMBER 2..... Don't forget rule Number 1

    Great moments often catch us unaware-beautifully wrapped in what others may consider a small one.

    I may not have gone where I intended to go,
    but I think I have ended up where I needed to be.

  12. #12
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    Hi ChemoMan,

    Thanks for directing me to the story...

    Yesterday, we consulted another oncologist and they said that this could be cured by 1 month of radiation(10 mins daily). While our existing oncologist insisted a month back that the radiation would make the cells to spread over the body. But he is not sure about the cure(almost said that this could not be cured) and trying only with the R-Chop. This recent oncologist also saying that the tumor wont spread like the existing doctor said. So we are planning to go with radiation. Is it a right decision? Also could anyone please tell me the side effects of radiation...

    Thank You all..........

  13. #13
    Administrator Top User Didee's Avatar
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    My stage of my cancer was 2b. Radiation standard practice after chemo to really zapp the beast.
    My opinion is ohhh heck yes it is the right decision.
    I have never heard mention of any spreading because of it.
    I did a month's worth too. One every week day. 18 treatments.

    My opinion is that as it is only in one spot, caught VERY early and if it was me I would be doing it.
    This is only my own personal opinion.
    Side effects from it is usually a burning of the skin, like a bad sunburn.
    As mine was also chest and base of the throat area I had to put up with the throat from hell.
    Aussie, age 57
    1987 CIN 111. Cervix lasered, no further problems.

    Dx Peripheral T Cell Lymphoma stage 2B bulky, aggressive Dec/09.
    6 chop14 and Neulasta.
    Clean PET April/10, 18 rads 36gy mop up. All done May 2010
    Iffy scan Nov. 2011.
    Scan Feb 2012 .still in remission.
    Still NED Nov 2012. On to yearly bloods now.

    May/2012. U/sound, thyroid scan, FNB. Benign adenoma. A lump in otherwords, nodule if you wish to be specific.

    CancerForums User Policy

    http://www.cancerforums.net/threads/...picture-policy

    Out of all the things I have lost, I miss my mind the most.

  14. #14
    Newbie Top User joepet's Avatar
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    All I can say is that recent trends are moving towards use of chemotherapy in any and all cases of your father's type of lymphoma. Radiation could work, but all of the data accumulated over decades points to chemotherapy giving the best chance of bringing about a cure.

    But only your father and his family can say what is right for him...

    EDIT: I made this post under the assumption that you were choosing between chemotherapy OR radiation. If the question is whether or not to do radiation AFTER chemotherapy, then you have to weigh the odds that chemo alone wouldn't cure the lymphoma against the additional risks posed by radiation treatment (and the fact that there is a "lifetime limit" on radiation that may prevent use of that tool in the case your father needs treatment for another cancer later on), which is a much more nuanced and difficult decision to make. If you go through the archives, you'll find a couple of threads and a lot of discussion devoted to that topic...
    My Story: http://cancerforums.net/viewtopic.php?t=11396
    Diffuse Large B cell Lymphoma
    Stage 1AE (localized in colon)
    Began six cycles of R chop 21 3rd Dec 2008
    Finished R chop 21 Apr 2009
    Complete remission as of May 2009
    Confirmed April 2010

  15. #15
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    I couldn't be clear why this is happening to even a initial staged NHL...

    A couple of days back my dad's tumor at groin came back, as always after 14 days. As I said in my previous posts, we have changed our oncologist and we have started the radiation(2 days completed). After seeing the aggresion, my onc said that it is unusual and trying radiation and chemo altogether(for first time now) should turn up something. She also said that if this isn't working we have to go for stem cell transplantation. We immediately approached our Radiation doctor. He said, we could say anything only after 15 days. Now I am really confused, if the stem cell transplantation is requied for NHL, which has not spread to any parts of the body and also staged 1AX.

    Can we be able to get improvement atleast after this time of treatment(with chemo and radiation)

    Any one please suggest me....

  16. #16
    Administrator Top User Kermica's Avatar
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    Manoj, I have been following this thread with interest and hope for your Dad. After reading through the entire string again, I believe that you should get a second opinion of your Dad's lymphoma samples from a hematologist who specializes in blood cancers as soon as you can. When DLBCL doesn't respond and the tumor keeps regrowing right away, it is often a sign that the original diagnosis was incorrect. It is possible that that is the case here but I am not a doctor.

    I think you should ask a qualified specialist at a major cancer center if it is possible that your father actually suffers from Burkitt's NHL or Burkittt's like lymphoma. It is clear from your posts that the therapies being applied are not being effective. I don't believe that the radiation with the chemo will do the trick but hope that I am wrong, of course, Manoj.

    Again, ask your doctor if the original diagnosis could have been wrong and if the slides could be re-examined by a doctor with a top reputation for dealing with lymphoma. I could be all wrong on this, Manoj, but there were so many questions around my original diagnosis that my oncologist got three opinions before proceeding. It made a difference in my treatment plan. Good luck to you and your father.

    Good health,

    kermica
    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 63
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09

    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.

    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.

    Significant progression detected in PET scan - December 2012

    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.

    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.

    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".

    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.

    June 2014 - started 2 year maintenance Rituxin, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.

    Remember the Rules!

  17. #17
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    Hi Manoj

    Sorry I only just picked this up.

    Yes our Son had LDBCL (same as your Dad) and had RCHOP 14 (every 14 days). He is now in complete remission and has been for 18 months.

    One of the factors they look at in the cycle time is the strength of the body to accept chemo more frequently. It's usually a good sign that they believe your Dad is strong enough to cope with this. There is no greater risk to the success of the treatment. A German study showed that success was the same in both cases but the time for treatment shorter.

    Best wishes to your Dad
    21 yr old male (Our Son)
    Diffuse Large B-Cell Non Hodgkins Lymphoma
    Stage 1A Mediastinal Mass 8cm x 7cm
    Diagnosed October 09
    Started course of 6 x R-CHOP 14 in Nov 09
    Course complete Jan 2010
    Remission declared March 4th 2010
    Continues in remission March 2014

  18. #18
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    Kermica,

    You are exactly saying what our new Oncologist said except the Burkittt's like lymphoma.

    I must also have said about the change of hospital in the previous posts. Ya, now we are in another hospital specially for Cancer. When we first explained the prevailing conditions to the new Onc, she immediately suggested for the pathology test of the biopsy sample again. We had given the sample for test 4 days back, will be getting back the results by start of the coming week.

    Will posts the status periodically...Any way we are continuing the same treatment for now by side
    Last edited by manokrrish; 09-02-2011 at 04:13 PM.

  19. #19
    Administrator Top User Kermica's Avatar
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    That's great, Manosh, that you have someone who is a specialist re-examining the data to see if a mistake was made. I think that, too often, people with blood cancers relax about things because they are seeing an oncologist when the truth is that oncologists mostly focus on solid tumors in the body. Hematologists are the specialists for blood cancers (or oncologists who specialize in them). For your father's sake, I hope they find that it is true and that a different therapy will achieve the result you are hoping to get. Keep us posted and good luck with the new oncologist.

    Good health,

    kermica
    When the world says, "Give up," Hope whispers, "Try it one more time."
    ~Author Unknown

    Age 63
    Follicular lymphoma diagnosed August 08, Stage 1
    2 cycles (20 treatments each) localized radiation to tumor sites. Remission confirmed July 09

    Restaged to Stage 3 May 2010
    Recurrence confirmed May 2010 - Watch and Wait commenced - multiple scans with minimal progression.

    Cutaneous Squamous Cell Carcinoma diagnosed September 2012. Mohs surgical excision 09/2012. Successful, clean edges all around.

    Significant progression detected in PET scan - December 2012

    Biopsy to check for transformation 1/18/2013 - negative for that but full of lymphoma, of course.

    July 2013 - Rescan due to progression shows one tumor (among many) very suspect for transformation, another biopsy 8/12/13.

    August 2013 - No evidence of transformation, 6 courses of B+R commence 8/29 due to "extensive, systemic disease".

    February 2014 - Diagnostic PET scan states: Negative PET scan. Previous noted hypermetabolic cervical, axillary, iliac and inguinal lymphadenopathy has resolved. Doctor confirms full remission.

    June 2014 - started 2 year maintenance Rituxin, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.

    Remember the Rules!

  20. #20
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    Hi,

    I am replying back after a long time it seems. Here are the things happened so while...

    We got the biopsy reports a week later and this too confirmed the DLBCL. In the mean time, we started our radiation along with chemo once in 2 weeks. With this both, this time the tumor had got controlled even after 2 weeks was exceeded. so we gave the last chemo after 17 days and my dad didn't feel any pain or any sign of it growing back. Also doc said that a good sign. Now we have finished 20 radiations out of 23(not sure if 23 is final) and 6 chemos. The lump has come down, still he got some part remaining. I couldn't be clear, if this could be cured in prescribed 8 cycles of chemos, If not would the doc suggest for few more chemos??? I am asking this because, he is feeling very tired with this 6 cycles itself(radiation would also be a reason)!!! Pls suggest...

 
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