Suggest treatment for non Hodgkin's lymphoma
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One of my relatives has been diagnosed with Lymphoma. The detailed Histopathology report is as follows: Clinical information: Non Hodgkin's lymphoma Material received: Biopsy left inguinal lymph node done elsewhere, slides for review Gross Examination: Received 1stained slide and 3 unstained slides labelled as 4379/14 A2, Slides for review and immunohistochemistry Microscopy and Diagnosis: Consistent with diffuse large B cell lymphoma Immunohistochemistry : The neoplastic cells express CD20, Cyclin D1(focal), and are negative for TdT. I would like to know about the implications, treatment and chances of being fully cured
Posted Thu, 13 Mar 2014 in Cancer
Answered by Dr. Manjeth Kumar G 2 hours later
Brief Answer: COmplete cure if inintiated at early stages.R-CHOP Detailed Answer: Hello, Thanks for your query. It is a good responsive tumor to Chemotherapy if treatment is initiated in early stages. There is large percentage of complete cure by Chemotherapy. Most widely used and choice of treatment by most hematooncologists is R-CHOP regimen. It is a combination of Monoclonal antibody with other chemotherapeutic drugs. The drugs are Doxorubicin, Cyclophosphamide and Vincristine, the steroid prednisolone, and a monoclonal antibody called Rituximab. The treatment may continue for 4 to 6 months. While on chemotherapy, he need monitoring of Hemoglobin, Complete blood count for every three weeks to identify any chemotherapy-related adverse effects. There are very number of patients have relapse after the treatment. If there is a relapse better consider Stem Cell transplantation after discussion with the Hematooncologist. Hope this helps. Please write back for further queries.
Follow-up: Suggest treatment for non Hodgkin's lymphoma 43 hours later
The oncologist whom my relative is seeing is planning to use the following: Inj Restova 600 mg Endoxan 1200 mg VCR 2 m g Inj Nudoxa 50 mg On discharge- Inj Nuepes Also a bone marrow test was done - the brief result is mentioned below: Bone marrow smear result shows- Cellular marrow with Trilineage heamatopoiesis, suspec lymphomatous involvement of marrow on aspirate. Please let us know your suggestions and opinion on the bone marrow test result. regards,
Answered by Dr. Manjeth Kumar G 18 hours later
Brief Answer: bone marrow involved. start Chemo-Immunotherapy. Detailed Answer: Hello, Thanks for your reply. As i stated earlier, Your oncologist want to start R-CHOP regimen. Bone marrow report shows the Bone marrow involvement of Diffuse Large B cell Lymphoma. As bone marrow is involved, it is Stage 4 of the disease. I am a deeply unhappy to explain that survival rate of stage 4 disease is low and Otherwise the cellular marrow and Trilineage hematopoiesis are normal things and it indicates all the blood forming cells are present in the aspirate and there is no hyper or hypocellularity and Variation in Hematopoiesis. Just start Chemo with immunotherapy as instructed by your Oncologist and watch for any side effects of chemotherapy and treat it earlier. Hope this helps. Please write back for further queries. Wishing you good health.
Follow-up: Suggest treatment for non Hodgkin's lymphoma 24 hours later
Dear Doctor, Thanks for your response. The detailed bone marrow Aspiration and Biopsy report is enclosed. HISTOPATHOLOGY REPORT BONE MARROW ASPIRATION AND BIOPSY REPORT Clinical Information: ? Non Hodgkin's lymphoma. Previous bone marrow report, if any : Nil. Peripheral smear: Relative lymphocytosis with 15% atypical lymphocytes. Material received: 2 BMA in EDTA + 5 unstained BMA slides + 1PB in EDTA and bone marrow biopsy Gross Examination: Bone marrow aspiration : Smears prepared. Bone marrow biopsy : (Dr. P Sirisha) Received a single 0.5cm grey white bony core, entirely processed in one block. Microscopy Differential count Erythroid cells 31.0%, Myelocytes 2.0%, Metamyelocytes 9.0%, Neutrophils 17.0%, Lymphocytes 33.0%, Eosinophils 2.0%, Plasma cell 6.0%. Cellularity : Cellular marrow with trails. Erythropoiesis : Normoblastic pattern of maturation. Megaloblasts also seen. Leukopoiesis : Show cells in various stages of maturation. Lymphocytes : Increased, seen in small clusters and sheets; ranging in size from small to large . Plasma cells : Slightly increased (reactive). Megakaryocytes : Adequate. Few hypolobated forms seen. Other : No parasite/ granuloma seen. Bone marrow biopsy : Marrow shows mild hypocellularity with relative increase in atypical lymphoid cells. Crush artifact also seen. Impression : Shows involvement by lymphoma. Would like to know your views on this and whether the treatment suggested by our current oncologist is in line. Thanks and regards,
Answered by Dr. Manjeth Kumar G 23 hours later
Brief Answer: Yes. DLBCL. Start R-CHOP. Detailed Answer: Hello, Thanks for your reply. Yes. All the features are consistent with Diffuse Large B cell Lymphoma ( DLBCL). My advice is to start R-CHOP regimen as earlier as possible. Why it is DLBCL? 1. Presence of CD 20 in neoplastic cells by Immunohistochemistry confirms it is a mature B cell tumour. 2. Cyclin D1 is usually well positive in Mantle cell Lymphoma. But here it is focal and thus rules out Mantle cell lymphoma. 3. Tdt Negative rules out presence any Acute myeloid leukemia or Acute Lymphoid leukemia. 4. Bone marrow aspirate as well as Lymph node biopsy shows lymphomatous involvement. 5. Bone marrow biopsy and microscopy shows Increased lymphocytes and is also atypical. Usually Lymphocytes are below 20 % (Lymphocytes 33.0%). 6. Hypocelluarity is nothing but there is increased infiltration of fat in bone marrow. it is usual to have mild hypocellularity in as one grows old. As your doctor advised, please go for R-CHOP regimen. Because CD 20 positive tumors have good response to monoclonal antibodies treatment like Rituximab ( Restova). Hope this helps. Please write back for further queries. Wishing you good health.