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Hodgkin's Lymphoma, chemo treatment with epirubicin ,bleomycin. Curable?

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Posted on Wed, 9 May 2012
Question: I was recently diagnosed with Hodgkin's Lymphoma and started my chemo treatment. I was given Epirubicin,bleomycin,bleomycin,dacarbazine on day 1 and 15. What is a cycle then? how many cycles I need to take? My oncologist didn't say anything about the type or stage, is that information important for me to know? moreover can you tell me more about this diseases.
doctor
Answered by Dr. Indranil Ghosh (2 hours later)
Hi

Thank you for writing to us.

First of all, I think you have not mentioned the drugs properly. Bleomycin is repeated twice while vinblastin is missing.

A cycle constitutes of two doses, D1 and D15. Thus, one cycle is completed in a month's time.

Stage is very important in Hodgkin's lymphoma as treatment almost entirely depends upon stage. Early stage disease (I-II without risk factors) may be treated by 4 cycles chemo + radiation or six cycles chemo. But late stage disease (III-IV) will require at least six cycles chemo (with/without radiation). PET-CT scan may be repeated after 2 cycles to see the response. By risk factors I mean high ESR, B symptoms (fever, weight loss, night sweats, bulky lymph glands, etc). These factors increase the chances of relapse (disease coming back).

Hodgkin's lymphoma has at least four major subtypes, however, barring one (NLPHL type), treatment does not change much.

Having said all this, it is important for you to know that Hodgkin's lymphoma is an eminently curable disease if treated properly. However, you will need to be in lifelong follow-up to detect any recurrence or complications of treatment. Early complications of treatment include nausea, vomiting, weakness, loose motions, hairfall, infections, etc. Late effects include second cancers, heart or vessel diseases, lung diseases, etc. However, these are rare and occur in <5% patients.

Hope I have answered your query adequately. Please feel free to ask if you have any other queries.

Regards
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Indranil Ghosh (10 hours later)
Thanks for your immediate response doctor. Sorry, I missed vinblastin in my query here is the full list of medicines I'm currently taking

Day 1:
Epirubicin 70mg
Bleomycin 150x2
Vinblastin 10ml
Dacarbazine 200mgx5

Day 15:
Epirubicin 10mgx3
Bleomycin 150x1
Vinblastin 10ml
Dacarbazine 200mgx4

Apart from this, I'm taking Clokaran tablet 2mg (1-0-1), my oncologist advised me to take this tablet for 2 years. what is the purpose of this tablet ?

My immunohistochemisty result say I have Hodgkin's Lymphoma with CD30 Postitive and CD68a Positive Focal. Based on these information can you able to tell the subtype ?

According to my old PET scan result largest node size is 4.9x3.3, do I need to radiation ?

doctor
Answered by Dr. Indranil Ghosh (1 hour later)
Hello again,

I am sorry to say you that the regime you mentioned cannot be considered as a standard one. Clokaran is simply not acceptable in Hodgkin lymphoma.

CD30+ only does not ascertain the subtype. However, the important issue for you is not the subtype, but getting proper chemotherapy. I think you should immediately see a qualified medical oncologist (and NOT radiation oncologist, clinical oncologist or just oncologist).

You can visit Adyar cancer institute in Chennai (Dr Prasanth Ganesan MD, DM).

Please send me the detailed PET report. I don't think you need radiation as of now.

Hope this helps.

Regards,
Above answer was peer-reviewed by : Dr. Shanthi.E
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Follow up: Dr. Indranil Ghosh (7 hours later)
Thanks a lot for giving me right direction doctor. I have fixed a appointment with another medical oncologist in Apollo hosiptal.

Can you please let me know the standard regime atleast from next time onwards I will know whether I'm following the proper regime or not. Moreover I have already complete 1 cycle of chemotherapy what will be the side of that non-standard regime.

Will I able to live a normal life during my chemotherapy period ?



doctor
Answered by Dr. Indranil Ghosh (1 hour later)
Hi,

Thanks for follow up.

The standard regime for Hodgkin's Lymphoma (which is widely practiced the world over) is ABVD, ie. adriamycin, bleomycin, vinblastin and dacarbazine. Though the chemotherapy you received earlier was a bit different from this, we will have to take it as the first cycle.

You can certainly have a normal life during chemotherapy. You should follow up with your Oncologist and other allied health professionals (Psychologist, Dietitian etc) who can give you constant help during the chemotherapy and this certainly could bring quality life.

I wish you good health.

Best wishes,
Dr. Indranil
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Hodgkin's Lymphoma, chemo treatment with epirubicin ,bleomycin. Curable?

Hi

Thank you for writing to us.

First of all, I think you have not mentioned the drugs properly. Bleomycin is repeated twice while vinblastin is missing.

A cycle constitutes of two doses, D1 and D15. Thus, one cycle is completed in a month's time.

Stage is very important in Hodgkin's lymphoma as treatment almost entirely depends upon stage. Early stage disease (I-II without risk factors) may be treated by 4 cycles chemo + radiation or six cycles chemo. But late stage disease (III-IV) will require at least six cycles chemo (with/without radiation). PET-CT scan may be repeated after 2 cycles to see the response. By risk factors I mean high ESR, B symptoms (fever, weight loss, night sweats, bulky lymph glands, etc). These factors increase the chances of relapse (disease coming back).

Hodgkin's lymphoma has at least four major subtypes, however, barring one (NLPHL type), treatment does not change much.

Having said all this, it is important for you to know that Hodgkin's lymphoma is an eminently curable disease if treated properly. However, you will need to be in lifelong follow-up to detect any recurrence or complications of treatment. Early complications of treatment include nausea, vomiting, weakness, loose motions, hairfall, infections, etc. Late effects include second cancers, heart or vessel diseases, lung diseases, etc. However, these are rare and occur in <5% patients.

Hope I have answered your query adequately. Please feel free to ask if you have any other queries.

Regards