Lymphoma aggravating during Chemotherapy - 2 Cycles done

ashsaj

Hi all, my father being diagnosed of DLBCL - with mediastinal mass - covering lymph nodes above and below diaghpram , has received 2 rounds of R-CHOP - Since his symptoms are continously getting worse - his medical team at a general hospital suggested to change the oncologist - we changed the oncologist and newer one suggested a CT scan to check if R-CHOP is doing what is supposed to do. The CT scan reveals that lymphnodes are increasing and there is aggravation in masses as compared to the initial CT. 
Now the Oncologist seems very confused, he said R-CHOP is the standard treatment and it should work, As we have not received the Chemo in his hosp before - He suggested to go with the R-CHOP for this cycle under monitoring. My father has received another  cycle of R-cHOP yesterday - we are hell worried what if it does not work. we will be waiting for another 21 days before the next cycle. The Onc suggested if R-CHOP does not work we will have to move to a stronger Chemo may be R-ICE or R-DHP something. 
Can someone please suggest - or share their experience ? 
Is it possible that tumors might start shrinking or getting controlled after 3rd chemo? 

Regards,

Ayesha 

PBL

Pathology?

Hello Ayesha,

Sorry to read about your father's continuing illness. Perhaps your answers to these questions could help in finding a solution:

How was the diagnosis made? Was it through an excisional biopsy (i.e., the surgical removal of a whole lymph node) or a less thorough (core or fine needle aspiration) biopsy?

Where is your father being treated? Is it at a teaching hospital or a local hospital? Is his current oncologist a hematologist (a specialist for blood disorders)?

Has the pathology report been double-checked? Maybe having the slides sent to an expert pathologist could show some blip in the diagnosis...

I do hope some way can be found of solving this riddle...

Best of luck to you and your father.

PBL

Max Former Hodgkins Stage 3

PBL said:

Pathology?

Hello Ayesha,

Sorry to read about your father's continuing illness. Perhaps your answers to these questions could help in finding a solution:

How was the diagnosis made? Was it through an excisional biopsy (i.e., the surgical removal of a whole lymph node) or a less thorough (core or fine needle aspiration) biopsy?

Where is your father being treated? Is it at a teaching hospital or a local hospital? Is his current oncologist a hematologist (a specialist for blood disorders)?

Has the pathology report been double-checked? Maybe having the slides sent to an expert pathologist could show some blip in the diagnosis...

I do hope some way can be found of solving this riddle...

Best of luck to you and your father.

PBL

Similiar

Similiar to PBL's observation, I would think that your dad may have been misdiagnosed.  I would begin with a review of the biopsy at John's Hopkins or similiar institution.  While a second read of a biopsy at a place like John's Hopkins or Sloan Kettering is not cheap, it is way cheaper than getting the wrong therapy.  Failure of initial treatment is often linked to the doctors treating a disease the patient does not have.

Regardless, I would demand that the new oncologists give clear answers as to what is going on. If they won't then they are not any better than what he began with.    

Yes, there is some chance that Infusion 3 will turn the corner and begin to work, since some aggressive NHLs are just tough to beat back. That is, the diagnosis and treatment may in fact be correct, despite the lack of progress yet.  And sometimes even if R-CHOP IS the right choice, it is not powerful enough, and adjustments have to be made.  Most oncologists don't do a progress check CT until 3 infusions anyway.   I wish you and your dad the best, and good news soon,

max