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Suggest Treatment For Lymphoma And High Grade Follicular B Cell
Question: Hi Doctor XXXXXXX
I was dealing with you recently in relation to my brother. He has been diagnosed with Lymphoma.. high grade follicer.b cell.. he starts chemotherapy on thursday..the consultant mentioned to him that their aim of chemotherrapy is to get him in to remission asap..it is at the site of the duedudem..have you any advice.it has not been caused by a virus.. i gave you details in my last email..we are very concerned as the doctor said that he will die with this disease.no cure.
I was dealing with you recently in relation to my brother. He has been diagnosed with Lymphoma.. high grade follicer.b cell.. he starts chemotherapy on thursday..the consultant mentioned to him that their aim of chemotherrapy is to get him in to remission asap..it is at the site of the duedudem..have you any advice.it has not been caused by a virus.. i gave you details in my last email..we are very concerned as the doctor said that he will die with this disease.no cure.
Brief Answer:
Hi I would recommend the following.
Detailed Answer:
Dear Mam,
Yes I remember that your brother had an inflammatory bowel problem and then a lymphoma was suspected over it due to bleed complications. If the tissue diagnosis says high grade follicular B cell it might be that. Can you please upload that report too me so that I know what exactly is the lymphoma looks like by description from the Pathologist. Also let me know if a PET scan and a bone marrow biopsy was done to see the extent of the lymphoma as it is very essential to know the extent to determine the prognosis.
In any case however, proper early treatment is must and includes multiple drugs taken together that can help wipe out the lymphoma cells but at the same time cause weakness, some hair fall, blood in urine, weight changes and diarrhoea. However, if the remission ( treatment is successful after first few cycles) is reached then it is all worth it. Strict adherence to treatment is needed for that.
Please also let me know what regimen has your doctor decided to start on.
It is very difficult to say that someone is going to die soon due to his illness or not and it is very unfortunate that some one has to go through this, but all we can do is support him and provide him with the best possible care and happiness. Life is a fight and we must take every challenge on its toes and try to defeat it.
Please let me know if you have any concerns and also do let me know the information as I asked above.
I hope this helps mam.
Stay positive!!
Sincerely,
Dr Parth A Desai
Hi I would recommend the following.
Detailed Answer:
Dear Mam,
Yes I remember that your brother had an inflammatory bowel problem and then a lymphoma was suspected over it due to bleed complications. If the tissue diagnosis says high grade follicular B cell it might be that. Can you please upload that report too me so that I know what exactly is the lymphoma looks like by description from the Pathologist. Also let me know if a PET scan and a bone marrow biopsy was done to see the extent of the lymphoma as it is very essential to know the extent to determine the prognosis.
In any case however, proper early treatment is must and includes multiple drugs taken together that can help wipe out the lymphoma cells but at the same time cause weakness, some hair fall, blood in urine, weight changes and diarrhoea. However, if the remission ( treatment is successful after first few cycles) is reached then it is all worth it. Strict adherence to treatment is needed for that.
Please also let me know what regimen has your doctor decided to start on.
It is very difficult to say that someone is going to die soon due to his illness or not and it is very unfortunate that some one has to go through this, but all we can do is support him and provide him with the best possible care and happiness. Life is a fight and we must take every challenge on its toes and try to defeat it.
Please let me know if you have any concerns and also do let me know the information as I asked above.
I hope this helps mam.
Stay positive!!
Sincerely,
Dr Parth A Desai
Above answer was peer-reviewed by :
Dr. Sonia Raina
Many thanks for your email. You are very good. Apparentlythey have not done a bone marrow biosepsy as yet..it has not hit the vital organs.. perhaps you can could advise me alittle more about follicer lymphoma..what is the prognosis.i donothave the scans..fergal is going on R. Crop chemotherapy...aim to get him into remission asap..apparently it has not hit the vital organs
Brief Answer:
Hi I would recommend the following.
Detailed Answer:
Dear Mam,
Apparantely if the PET scan shows that bone marrow is not involved and if the vital organs are still spared, it seems like the lymphoma is still in its early staging. However, an accurate staging may still help, it seems as if it is still localized which is a positive to start with.
Follicular lymphomas are B cell origin lymphomas that represent B cells of follicle stage. High grade follicular lymphomas are ones which have poorer prognosis than normal follicular lymphomas however not as bad as other high grade lymphomas and they do respond to chemotherapy including RCHOP chemotherapy.
Yes it seems like the right chemotherapy to start with and you should go ahead with it as soon as possible. After 3-6 cycles the doctor will do a repeat assessement and see for remission and we should hope that he achieves it as soon as possible which is likely in this case. We can then hope for the best.
During the chemotherapy, your brother will feel some weakness and some problems that your doctor will explain in detail, but most important is to keep the spirits high, keep him moving and active and give him healthy diet during the cycles and also adequate fluids for drinking. Also try to maintain a relatively sterile environment around him and keep his surroundings clean as his immunity will weaken. Rest I believe will go as per planned.
I hope this helps mam.
Let me know if you have any more questions or concerns.
Wish you and your brother all the very very best.
Sincerely,
Dr Parth Desai
Hi I would recommend the following.
Detailed Answer:
Dear Mam,
Apparantely if the PET scan shows that bone marrow is not involved and if the vital organs are still spared, it seems like the lymphoma is still in its early staging. However, an accurate staging may still help, it seems as if it is still localized which is a positive to start with.
Follicular lymphomas are B cell origin lymphomas that represent B cells of follicle stage. High grade follicular lymphomas are ones which have poorer prognosis than normal follicular lymphomas however not as bad as other high grade lymphomas and they do respond to chemotherapy including RCHOP chemotherapy.
Yes it seems like the right chemotherapy to start with and you should go ahead with it as soon as possible. After 3-6 cycles the doctor will do a repeat assessement and see for remission and we should hope that he achieves it as soon as possible which is likely in this case. We can then hope for the best.
During the chemotherapy, your brother will feel some weakness and some problems that your doctor will explain in detail, but most important is to keep the spirits high, keep him moving and active and give him healthy diet during the cycles and also adequate fluids for drinking. Also try to maintain a relatively sterile environment around him and keep his surroundings clean as his immunity will weaken. Rest I believe will go as per planned.
I hope this helps mam.
Let me know if you have any more questions or concerns.
Wish you and your brother all the very very best.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Naveen Kumar
thank you.. is the treatment that Fergal is going to go on..very aggressive form of treatment
is it safe for him to work..etc.. will he be sick..he lives alone so i am alittle concerned...there is a large amount in the duedem.. big size and also some in the neck and the groin..
is it safe for him to work..etc.. will he be sick..he lives alone so i am alittle concerned...there is a large amount in the duedem.. big size and also some in the neck and the groin..
Brief Answer:
Hi I would recommend the following.
Detailed Answer:
Dear Mam,
Thank you for your reply.
The prognosis for follicular lymphomas depend on the grade and stage with extent of the disease. For stage 3 and 4 also the 5 year survival rate is 80% ie at the end of 5 years 8 out of 10 patients can make it through. Again these are just numerical values based on large studies and with each patient we try to give our best and the actual prognosis is always uncertain.
Regarding the routine during the chemotherapy cycles, RCHOP is not a very aggressive chemotherapy regimens like others, but yes it takes some toll on body like weakness, fatigue, mild to moderate hair loss in some patients, lack of appetite and nausea and constipation. However, I have seen many patients who gradually start working despite being on the treatment. The initial cycle is the toughest since the patient does not know exactly what to expect but it becomes better once the body gets to know the size and type of the blow.
I know you are concerned and it is very difficult situation for you too but it is very appreciative of you to provide him with whatever support you can do. Do ensure that he always carries his blood group, emergency contact info card in his pocket and lets you or any of his close relatives know about his movements and travel. Rest can be done as I adviced in my previous answer.
I hope this helps mam.
Let me know if you have any other question or concern.
Sincerely,
Dr Parth Desai
Hi I would recommend the following.
Detailed Answer:
Dear Mam,
Thank you for your reply.
The prognosis for follicular lymphomas depend on the grade and stage with extent of the disease. For stage 3 and 4 also the 5 year survival rate is 80% ie at the end of 5 years 8 out of 10 patients can make it through. Again these are just numerical values based on large studies and with each patient we try to give our best and the actual prognosis is always uncertain.
Regarding the routine during the chemotherapy cycles, RCHOP is not a very aggressive chemotherapy regimens like others, but yes it takes some toll on body like weakness, fatigue, mild to moderate hair loss in some patients, lack of appetite and nausea and constipation. However, I have seen many patients who gradually start working despite being on the treatment. The initial cycle is the toughest since the patient does not know exactly what to expect but it becomes better once the body gets to know the size and type of the blow.
I know you are concerned and it is very difficult situation for you too but it is very appreciative of you to provide him with whatever support you can do. Do ensure that he always carries his blood group, emergency contact info card in his pocket and lets you or any of his close relatives know about his movements and travel. Rest can be done as I adviced in my previous answer.
I hope this helps mam.
Let me know if you have any other question or concern.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Prasad
many thanks.. my brother started his chemo. today..they are going to do a bone marrow test.is this a good sign..they said there was not a need...how long do people normally stay out of remission
Brief Answer:
Hi I would recommend the following
Detailed Answer:
Dear Mam,
Thank you for your reply.
So generally most hematologist prefer to do a bone marrow in initial stages of treatment to absolutely make sure that marrow is not involved (even though it may be negative on PET Scan). It helps later onto check for signs of remission. If there is a complete remission it can remain for longer periods of times in terms of fews years. Exact figure is difficult to estimate but our main goal is to achieve as good a remission as possible within first 4-6 cycles.
I wish you and your brother very best with the chemotherapy.
Let me know if you have any questions or concerns mam.
Sincerely,
Dr Parth Desai
Hi I would recommend the following
Detailed Answer:
Dear Mam,
Thank you for your reply.
So generally most hematologist prefer to do a bone marrow in initial stages of treatment to absolutely make sure that marrow is not involved (even though it may be negative on PET Scan). It helps later onto check for signs of remission. If there is a complete remission it can remain for longer periods of times in terms of fews years. Exact figure is difficult to estimate but our main goal is to achieve as good a remission as possible within first 4-6 cycles.
I wish you and your brother very best with the chemotherapy.
Let me know if you have any questions or concerns mam.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
they did not do a scan for biocepy...can you let me know why.thanks..he has started the RCrop
Brief Answer:
Hi I would recommend the following.
Detailed Answer:
Dear mam,
thank you for your reply.
They generally do not do a scan but do a bone marrow biopsy separately. However if PET scan is negative biopsy is avoided by some hematologist but done by some. It varies for every clinician based on his experience.
Anyways it is great that he is now on chemotherapy. Remember 1st cycle is sometimes the hardest to go through and after that things do get easier as body competes and adjusts.
He will require your full support and love.
I hope this helps.
Wish you all the very best mam.
Let me know if you have any other questions.
Sincerely,
Dr Parth Desai
Hi I would recommend the following.
Detailed Answer:
Dear mam,
thank you for your reply.
They generally do not do a scan but do a bone marrow biopsy separately. However if PET scan is negative biopsy is avoided by some hematologist but done by some. It varies for every clinician based on his experience.
Anyways it is great that he is now on chemotherapy. Remember 1st cycle is sometimes the hardest to go through and after that things do get easier as body competes and adjusts.
He will require your full support and love.
I hope this helps.
Wish you all the very best mam.
Let me know if you have any other questions.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Naveen Kumar
thank you so much.. should alcohol be avoided and should he be working..i find your advise excellent..also i think i mentioned before that he has already had part of his bowel removed and reversed due to crohns.. would this be related to lymphoma
Brief Answer:
hi i would recommend following.
Detailed Answer:
Dear mam,
Thank you for your query. I would advice to refrain from alcohol as much as possible as it might affect his recovery if taken in excess. Also he can go to work if he feels better. As such there is no contradiction and its better to return to normalcy as soon as possible.
Some lymphomas including b cell are related to inflammatory bowel conditions like crohns disease and it can be a causative factor. However it does not change his current treatment in anyway.
I hope this helps.
Let me know if you have any concerns.
Wish him all the very best mam.
Sincerely,
Dr Parth Desai.
hi i would recommend following.
Detailed Answer:
Dear mam,
Thank you for your query. I would advice to refrain from alcohol as much as possible as it might affect his recovery if taken in excess. Also he can go to work if he feels better. As such there is no contradiction and its better to return to normalcy as soon as possible.
Some lymphomas including b cell are related to inflammatory bowel conditions like crohns disease and it can be a causative factor. However it does not change his current treatment in anyway.
I hope this helps.
Let me know if you have any concerns.
Wish him all the very best mam.
Sincerely,
Dr Parth Desai.
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Above answer was peer-reviewed by :
Dr. Raju A.T
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