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Diagnosed with Lymphoma. Suggest availability of monoclonal antibodies. Treatment possible?

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Hi!
I m XXXXXXX [ Male, 35 yrs, 68 Kg, Unmarried ] Recently i have been diagnosed with Primary Cutaneous Non Hodgkin's Lymphoma Expressing CD 30 type & ALK-1 Negative.
[ No Systemic Involvement ]
Except for Immunohistochemistry of biopsy sample[CD3, CD4, CD30 +VE & CD8, CD20 -VE ] all blood & other reports are normal.
I do not suffer from Fever or weight loss.
Pls suggest treatment options & availability of monoclonal antibodies.
Pls refer to the attachments.
Posted Tue, 1 May 2012 in Skin Cancer
 
 
Answered by Dr. Indranil Ghosh 21 hours later
Hello.

Thanks for posting your query.

I could not open the first attachment of your's. If possible, post it again.

I think you have got primary cutaneous anaplastic large cell Lymphoma which is a type of proliferation of T-cells (immune cells) in the skin.

It is mostly ALK negative and free from systemic involvement, as in your case. This disorder is very indolent (harmless) and treatment results are very satisfactory.

If you have disease localized to a particular area of skin (which is most probable), then the treatment is surgical excision with or without radiation. If you have patches at multiple places in the skin, then low dose chemotherapy may be required.

There are no monoclonal antibodies available at present for this condition, but even without these, results are very good.

In all probability you will have a normal life in the future.

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Lymphoma. Suggest availability of monoclonal antibodies. Treatment possible? 4 hours later
Thanks Dr. Indranil!
Yes, I have been diagnosed with primary cutaneous anaplastic large cell Lymphoma
My disease is not localized but it's spread at a few locations. [ Pls refer to the attachment ].
I m told by most of the oncologist that it is a vary rare condition & they want to study & observe my case. [ Is it true ? ]

Actually I don't want to push myself in to chemotherapy without definite need of it.

Some oncologist have advised CHOP chemo but I have read & learned that there are many therapies available like PUVA, Interferons, topical chemotherapy, Total Skin Electron Beam therapy etc. for which most of the doctors are reluctant to or simply ignore.

I wish to know ur opinion on these.

One of the oncologist has said that we can only observe the lesions & take the treatment only if they start troubling [ Like ulceration, etc. ].

As u have also mentioned low dose chemo may be required; what type u r referring to? [ As some have suggested low dose MTX ].

Pls elaborate ur approach to the treatment & ask for any additional info. if required.

Regards

 
 
Answered by Dr. Indranil Ghosh 8 hours later
Thanks for writing again and also for sending the picture. I have seen it.

As you have multifocal disease, observation is not recommended. Observation may be feasible mostly in the related disorder of lymphoid papulosis, which shows frequent spontaneous regression. Though spontaneous regression is documented in cutaneous ALCL ( Anaplastic Large Cell Lyhmphoma) also, it is rare, that too in mostly unifocal disease.

Looking at the photograph, I feel the most suitable therapy for you is low dose Methotrexate. I would not suggest CHOP ( Cyclophosphamide, Hydroxydaunorubicin, Oncovin (vincristine), Prednisone or prednisolone) treatment at present. Please discuss with your treating doctor regarding the same.

Other treatment modalities, like PUVA, Interferons, topical chemotherapy, Total Skin Electron Beam therapy are mostly suited to lymphoid papulosis or another condition, mycosis fungoides.

Hope I answered all your questions. Please accept my answer in case you do not have further queries. Wish you Good Health.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Lymphoma. Suggest availability of monoclonal antibodies. Treatment possible? 3 hours later
Thanks Dr. Indranil!
I have some lesions which have regressed [ Refer attachment ] & some are regressing.
In any case i would only like to know the possible side effects of low dose MTX & other medication / care to be taken to reduce them.
Regards,
Sachin
 
 
Answered by Dr. Indranil Ghosh 3 hours later
Hello XXXXXXX

Thanks for following up.

Yes, I think the lesions near knee are regresing. But the rest I can comment only after observing for some time.

The final decision to observe or treat immediately rests upon your clinician and I agree that waiting for few weeks will not alter the final outcome.

Regarding low dose MTX (Methotrexate), overall its a safe drug but expected side effects are nausea/vomiting, altered liver functions, infection risk (if blood counts fall). You should have regular blood tests (counts and LFT) to monitor for these.

Hope, this answers your query. Please accept my answer in case you do not have further queries.

Wish you good health.

Regards.
Above answer was peer-reviewed by
 
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