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Suggest Treatment For Follicular Lymphoma
Question: I was diagnosed with Follicular lymphoma last year and I recently had a bone marrow biopsy. The results for the aspiration show that the smear was paucispicular and paucicellular showing multilinear hematopoiesis with maturation. It also says that there was negative for overt involvement by clonal B-Cells. Results also show that the cytospin shows predominantly maturing elements at full range of maturation. Myeloblasts or lymphoid cells are not overtly increased. The myeloid and erythroid elements show full range of maturation with no overt morphologic evidence of dyspoiesis. Can you please tell me what this all means?
Brief Answer:
Hi was a bone marrow biopsy also done with bone marrow aspirate?
Detailed Answer:
Dear Mam,
I did review your concern. I can understand that you have been through a lot with follicular lymphoma. I believe since you were kept on observation it must have been early stage disease on PET scan.
Bone marrow aspirate and biopsy are done to stage lymphomas and involvement would mean initiation of treatment plans are needed, However, your aspirate report seems to be normal and there is no involvement on aspirate smears by malignant B cells. Although the aspirate yielded low cellularity which may sometimes happen randomly. but cellular contents of normal constituents are present in normal ratios.
But, For follicular lymphomas, bone marrow biopsy is a better means of identifiying involvement then bone marrow aspirate, since biopsy helps in seeing marrow space architecture and these slow lymphomas can cause focal involvement initially which is better caught on Biopsy.
So I would like to know if the bone marrow biopsy report is avaliable.
Also let me know your recent hemoglobin, platelets and white cell counts.
I hope this helps
Wish you all the best
Let me know if you have any questions or concerns.
sincerely,
Dr Parth Desai
Hi was a bone marrow biopsy also done with bone marrow aspirate?
Detailed Answer:
Dear Mam,
I did review your concern. I can understand that you have been through a lot with follicular lymphoma. I believe since you were kept on observation it must have been early stage disease on PET scan.
Bone marrow aspirate and biopsy are done to stage lymphomas and involvement would mean initiation of treatment plans are needed, However, your aspirate report seems to be normal and there is no involvement on aspirate smears by malignant B cells. Although the aspirate yielded low cellularity which may sometimes happen randomly. but cellular contents of normal constituents are present in normal ratios.
But, For follicular lymphomas, bone marrow biopsy is a better means of identifiying involvement then bone marrow aspirate, since biopsy helps in seeing marrow space architecture and these slow lymphomas can cause focal involvement initially which is better caught on Biopsy.
So I would like to know if the bone marrow biopsy report is avaliable.
Also let me know your recent hemoglobin, platelets and white cell counts.
I hope this helps
Wish you all the best
Let me know if you have any questions or concerns.
sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Prasad
Hi Dr. Desai,
That helps. I had the biopsy done but the results have not come in yet. I have been battling this for some time now and am always so tired. My life has not been the same for some time now. I have swelling in the legs, arms, face and abdomen and hurt easy. My staging was set at 2E before the PET and biopsy. A lymph node biopsy was done last year which ended with my diagnosis. In your opinion, should a person wait or start treatment so that it does not get out of control. Also, I was told Chemo is the way to go but am looking for another opinion. I read some about the prognosis of this disease and do not really understand much. Can you explain. I thank you for your quick response and wishes. XXXXXXX
That helps. I had the biopsy done but the results have not come in yet. I have been battling this for some time now and am always so tired. My life has not been the same for some time now. I have swelling in the legs, arms, face and abdomen and hurt easy. My staging was set at 2E before the PET and biopsy. A lymph node biopsy was done last year which ended with my diagnosis. In your opinion, should a person wait or start treatment so that it does not get out of control. Also, I was told Chemo is the way to go but am looking for another opinion. I read some about the prognosis of this disease and do not really understand much. Can you explain. I thank you for your quick response and wishes. XXXXXXX
Brief Answer:
Hello, Follicular lymphomas are generally good prognosis lymphomas.
Detailed Answer:
Dear XXXXXXX
sorry for late reply.
I think for 2E stage and if bone marrow biopsy is negative and the nodes are not bulky it is a good option to wait but it depends from oncologist to oncologist on whether to start treatment as 2E is in that intermediate range where we think treatment vs toxicity risk (from treatment). However,if there is an increase a size in any visible lymph node suddenly then I would recommend consult your oncologist and get advice on proper initial regimen to begin with for sure.
I think your best bet for 2E is to wait for biopsy report and take from there on. Generally the prognosis of follicular lymphomas is good unless they have grade 3B on histology where it can progress to diffuse large B cell lymphoma.
As far as options other than chemotherapy, there is an option of radiotherapy for localized disease, but for me it depends on site of disease as Radiotherapy is accompanied by side effects on local organs and Needs to be reviewed carefully.
I would personally start with standard Bendamustine plus rituximab if the PET shows bulky dieases or if Bone marrow biopsy is positive.However, I think your oncoloist is the best person to decide that.
I hope this helps
Let me know if you have any more questions or concerns.
Wish you all the best.
Sincerely
Dr Parth Desai.
Hello, Follicular lymphomas are generally good prognosis lymphomas.
Detailed Answer:
Dear XXXXXXX
sorry for late reply.
I think for 2E stage and if bone marrow biopsy is negative and the nodes are not bulky it is a good option to wait but it depends from oncologist to oncologist on whether to start treatment as 2E is in that intermediate range where we think treatment vs toxicity risk (from treatment). However,if there is an increase a size in any visible lymph node suddenly then I would recommend consult your oncologist and get advice on proper initial regimen to begin with for sure.
I think your best bet for 2E is to wait for biopsy report and take from there on. Generally the prognosis of follicular lymphomas is good unless they have grade 3B on histology where it can progress to diffuse large B cell lymphoma.
As far as options other than chemotherapy, there is an option of radiotherapy for localized disease, but for me it depends on site of disease as Radiotherapy is accompanied by side effects on local organs and Needs to be reviewed carefully.
I would personally start with standard Bendamustine plus rituximab if the PET shows bulky dieases or if Bone marrow biopsy is positive.However, I think your oncoloist is the best person to decide that.
I hope this helps
Let me know if you have any more questions or concerns.
Wish you all the best.
Sincerely
Dr Parth Desai.
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Above answer was peer-reviewed by :
Dr. Raju A.T
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