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Thread: Treatment Options for NHL Stage I & II

  1. #1
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    Treatment Options for NHL Stage I & II

    According to the National Comprehensive Cancer Network (US) Guildlines that was given to me by my mom's onc, the standard treatment for stage I and II for diffuse large b-cell lymphoma is RCHOP x 3cycles +RT or RCHOP x 6 cycles with or without RT (stage IIB for RT). My mom has stage IA gastric lymphoma and the doctor said her chemo could be as little as 3 cycles of RCHOP21 with radiation. I should have asked the onc this, but what determines the number of cycles given? Is one better than the other? My mom would love to have only 3 cycles of chemo, but would that be best for the long run? From almost all the posts I've read about RCHOP, almost everyone has had at least 6 cycles of RCHOP. I'll meet with my mom's onc this coming Thursday, but I would love to hear from you guys regarding this issue. Thanks!
    Age: 56yrs young (my mom)
    Diagnosis: 10/7/11
    Staged: 10/31/11
    NHL Diffuse Large B-Cell Lymphoma Stage 1E non-bulky (localize in stomach)
    R-CHOP 21 and Nulasta: Started 11/11; 4 down, 2 more to go!
    NED!!!!: 1/12

  2. #2
    Administrator Top User Didee's Avatar
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    Hi there. Welcome to the forum but I am sorry you have to seek us out.
    I can not comment on the treatment plan as I have another subtype. I am/was stage 2 and the protocols for mine was 6 CHOP then radiation to mop up.

    Write any questions down to take with you to the appointment.
    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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  3. #3
    Administrator Top User Kermica's Avatar
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    Hello and welcome, txgrace. From what I have read, it is not unusual for RCHOP to be administered in 3 rounds when the DLBCL is localized and low stage. That approach minimizes the impact of the chemo with a good chance of eradicating the cancer. By all means ask the doc why this path is being chosen but it is not unusual. There are others here with more direct knowledge than I since I have not had chemo yet and I am sure they will be weighing in at some point.

    Good luck to you and to your Mom.

    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!

  4. #4
    Newbie Top User joepet's Avatar
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    Welcome txgrace.

    I was diagnosed with Stage 1 gastrointestinal Diffuse Large B-Cell lymphoma (DLBCL) in late 2008. My doctor advised on 6 cycles of R-CHOP with no radiation, based in recent research that he says shows that, with Rituxan, the full cycle without radiation offered the best chance of a cure. Another consideration is that there is a lifetime limit to the amount of radiation one can receive, and given that those with lymphoma have a higher than average chance of coming down with a secondary cancer at some point in their life, it is better to leave the radiation option in the "toolbox" for potential use down the road.

    Not saying that this is the correct course of action for you, but this was how my onc explained to me. Perhaps you could ask the onc to detail his rationale for the regimen he has chosen?

    EDIT: I would also like to comment on what appears to be your assumption that radiation is necessarily "easier" than chemotherapy. Compared to other forms of chemotherapy, R-CHOP is usually well-tolerated, what we like to call "doable", while radiation therapy also has potential side-effects, which may be amplified by targeting such a delicate area as the stomach. I think some forum regulars have had the experience that the chemotherapy portion of treatment was actually easier than the radiation.

    Good luck with whatever choice you make.
    Last edited by joepet; 11-07-2011 at 08:10 PM.
    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

  5. #5
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    Thank you all for your input! My mom and I will meet with her onc Thursday and I'll have my questions written down so I won't forget to ask. Also, I don't think radiation is "easier" than chemotherapy. Both have some sort of toxicity to the body and both requires time to recover. I honestly don't know if one is better than the other. My mom would prefer a shorter treatment because she has to take time off work due to the fact that she works with large crowds of people every day. The assumption was made that 3 cycles of chemo and 1 month of radiation is shorter than 6 cycles of chemo. And by "shorter" I mean in actual therapy time, this does not take in account the recovery time for the treatments. We will definitely take into consideration the life time limit of radiation and will discuss with her onc. Her chemo will start next Wednesday!
    Age: 56yrs young (my mom)
    Diagnosis: 10/7/11
    Staged: 10/31/11
    NHL Diffuse Large B-Cell Lymphoma Stage 1E non-bulky (localize in stomach)
    R-CHOP 21 and Nulasta: Started 11/11; 4 down, 2 more to go!
    NED!!!!: 1/12

  6. #6
    Administrator Top User Didee's Avatar
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    I wouldn't be thinking which way would be the shortest duration but which way gives the best chance at remission.
    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.

  7. #7
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    Didee, I agree. That's what I told my mom. Work can always wait, its time for her to focus on getting better for the long run.
    Age: 56yrs young (my mom)
    Diagnosis: 10/7/11
    Staged: 10/31/11
    NHL Diffuse Large B-Cell Lymphoma Stage 1E non-bulky (localize in stomach)
    R-CHOP 21 and Nulasta: Started 11/11; 4 down, 2 more to go!
    NED!!!!: 1/12

  8. #8
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    I spoke with my mom's oncologist this past week and he said the therapy depends on how well my mom takes R-CHOP and its side effects. If she can handle the side effects well then they'll keep her on 6 cycles. If not, then they'll do 3 cycles and radiation. They'll keep her on surveillance by getting a CT scan of her every two cycles of R-CHOP. Her first R-CHOP will start this week! Lets hope it goes well!
    Age: 56yrs young (my mom)
    Diagnosis: 10/7/11
    Staged: 10/31/11
    NHL Diffuse Large B-Cell Lymphoma Stage 1E non-bulky (localize in stomach)
    R-CHOP 21 and Nulasta: Started 11/11; 4 down, 2 more to go!
    NED!!!!: 1/12

  9. #9
    Administrator Top User Kermica's Avatar
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    Txgrace, I hope your Mom's treatment goes as well as possible and the side effects are few and mild. Good luck!

    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!

  10. #10
    Administrator Top User ChemoMan's Avatar
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    Quote Originally Posted by txgrace View Post
    I spoke with my mom's oncologist this past week and he said the therapy depends on how well my mom takes R-CHOP and its side effects. If she can handle the side effects well then they'll keep her on 6 cycles. If not, then they'll do 3 cycles and radiation. They'll keep her on surveillance by getting a CT scan of her every two cycles of R-CHOP. Her first R-CHOP will start this week! Lets hope it goes well!
    Hi TX

    I hope everything goes well with Mum this week, 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.

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    but I think I have ended up where I needed to be.

  11. #11
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    Thank you all for your well wishes! I thought her first chemo will be pretty rough because she did not react very well to the pain killers the doctor prescribed to her after her PICC surgery she had on Tuesday. The night and before and the morning of her chemo, she was dizzy, vomiting, and had major headaches. I was so nervous driving her to hospital, I didn't know how she will make it through the day in the shape she's in. I told her nurse about her symptoms and the she hooked my mom up anti-nausea IV and benedryl and my mom felt 100% better almost immediately! The R-CHOP chemotherapy session lasted a good 8 hours with a minor rash on her back, but that's pretty much it. Afterwards, she felt pretty good and had a lot of energy, but had to take it easy because of the benedryl. The next morning I took her to get her booster shot to boost up her white cell count. She had a lot of energy in the morning and afternoon, but started to have headaches in the evening and felt tired. I gave her some anti-nausea and headache medications. In the middle of the night she said she felt hot in the head, then had the shakes. I was worried she had a fever, but when I checked her temperature she was normal. This morning she feel tired, but still wants to move around. What do you take to help with the headaches? All advice is welcomed!

    -Grace
    Age: 56yrs young (my mom)
    Diagnosis: 10/7/11
    Staged: 10/31/11
    NHL Diffuse Large B-Cell Lymphoma Stage 1E non-bulky (localize in stomach)
    R-CHOP 21 and Nulasta: Started 11/11; 4 down, 2 more to go!
    NED!!!!: 1/12

 
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