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

  1. #1
    Regular User
    Join Date
    Aug 2011

    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
    Join Date
    Jul 2009
    New York
    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,

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

    Age 66
    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 Rituxan, 1 infusion every 3 months. Doctor confirms lump under right arm are "suspicious" for recurrent disease, deferring scans for now.
    February 2015 - Doc and I agreed to stop R maintenance as it is depressing my immune system too much.
    June 2015 - Confirm that the beast is back by physical exam, will scan in August after esophageal issues settle down so we can get a clear view.
    August 2015 - physical exam in error, PET/CT shows no evidence of disease. Remission continues well into second year!
    December 2015 - Cardiologist tells me I have plaque buildup growing at an alarming rate. Stent or bypass down the road but not yet...
    March 2016 - new tumor below the jaw so remission is over. Back to active surveillance until treatment is needed.
    June 2016 - C/T scan indicates presence of multiple lesions in iliac chain.
    August 2016 - PET/CT shows multiple areas of lymphoma as expected plus new areas of concern in bowel.
    January 2017 - C/T scan shows significant progression in cervical and inguinal lymph chains, largest tumor is impacting hearing, measures 2.1x4.6 cm. 4 to 8 cycles of R-CVP, 1x3weeks to commence 2/6/17.
    April 2017 - Mid treatment scan shows about 1/3 reduction in multiple tumors. Also shows abdominal aortic aneurysm with peripheral thrombus. Cardiologist changed meds, spoke of need for surgical repair down the road.
    September 2017 - finished 10 rounds of R-CP, V was stopped due to neuropathy in feet. No further treatment planned at this time, at least 10 tumors can be felt which seem to be growing again.

    December 2017 - Biopsy of external iliax node with SUV of 13.1 shows no transformation! However, the FL grade is now 3A instead of Gr 1-2. Will start indefinite protocol using Copanlisib, one of the new targeted therapies. I remain hopeful.

  3. #3
    Top User joepet's Avatar
    Join Date
    Dec 2008
    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
    Join Date
    Jun 2010
    NSW Australia
    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 61
    1987 CIN 111. Cervix lasered, no further problems.

    Years of pain, bleeding, women's plumbing problems. TV ultrasound, tests, eventual hysterectomy 2007, fibroids in lining of Uterus.

    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.
    Discharged Nov 2014.

    May/2012. U/sound, thyroid scan, FNB. Benign adenoma.

    Relapse Apr 2016. AITL. Some chemos then on to allo transplant. Onc says long remission was good. Still very fixable.

    SCT Aug 2016

  5. #5
    Senior User rizza's Avatar
    Join Date
    Jan 2010
    Melbourne, Australia
    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
    Join Date
    Apr 2011
    South Milwaukee, Wisconsin
    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!
    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

  7. #7
    Regular User
    Join Date
    Aug 2011
    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
    Join Date
    Jun 2008
    South Australia
    Blog Entries
    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....

    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 60
    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 AND DECLARED CURED on the 2/01/2013

    No more scheduled visits to the Prof

    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
    Regular User
    Join Date
    Apr 2009
    Hyderabad, India
    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


  10. #10
    Regular User
    Join Date
    Aug 2011

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


    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?


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