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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How to check that the chemo is killing the cancer cells and the disease is not progressing?

My Father,67 years, was diagnosed with NHL diffuse large B cell type lymphoma , about 2 months ago. Staged as 1. He was recommended 6 cycles of R-CHOP. He has completed 2. since the last 7-8 days he has been complaining of fever, initially low grade but over the last 3-4 days reaching to 99.5 and 100. fever subsides readily with paracetamol and he feels absolutely fit, but reoccurs after 5-6 hrs. He has no other complaint, no clear signs of infection. WBC count was 5000 about 5 days ago now it is 9000. Chest X ray is normal. Preliminary urine analysis is normal. Good appetite, no gastric complaints. He has been started on antibiotics (ceftum) 5 days ago but no relief. - could it be that the lymphoma is progressing and not being controlled by chemo?? - how to check that the chemo is really killing the cancer cells? that the disease is not progressing?
Fri, 25 Oct 2013
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Pathologist and Microbiologist 's  Response
Hi!
welcome to HCM!
In most cases, the treatment for diffuse large B-cell lymphoma (DLBCL) is chemotherapy, usually with a regimen of 4 drugs cyclophosphamide, doxorubicin, vincristine, and prednisone, plus the monoclonal antibody rituximab . This regimen, known as R-CHOP, is usually given for about 6 months.
Rituximab is a type of biological therapy . Rituximab targets a protein known as CD20. CD20 is found on white blood cells called B cells. It is the B cells that are cancerous in the most common type of non Hodgkin lymphoma. Rituximab attaches itself to the B cells and marks them. The cells of the immune system recognise the marked cells and kill them.
An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and patient can become very ill.
DLBCL can be cured in about half of all patients, but the stage of the disease and the IPI score can have a large effect on this. Patients with lower disease stages have better survival rates, as do patients with lower IPI scores.
hope this helps!take care!
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