4 vs 6 cycles of R-CHOP for DBC-NHL

TeriS

Does anyone have any experience or research on going 4 cycles instead of the recommended 6-8 for diffuse large B cell non-hodgkins lymphoma?

I found an article titled: (this site won't let me share the link but you can find it via Google search)

Treatment With Four Cycles of R-CHOP Is Non-Inferior to Six Cycles in Some Aggressive B-Cell Non-Hodgkin Lymphomas

I have no co-morbidities and am tolerating the chemo fairly well so far, with the help of a lot of supplements from my functional medicine doctor. But I also want to avoid anymore damage to my body.

Just wondering if anyone has come up against this same decision and willing to share your research and/or experience.

Thanks in advance!

po18guy

This is a tough one. Much input is needed from your medical team in making the decision. Disease stage, tumor burden, tumor location, involved organs, the immunophenotype of the tumors, the degree of aggressiveness and other data will all factor in. What must be borne in mind is that the cancer will be more difficult to defeat if it relapses. This leans toward going the extra rounds. Preserving your body's condition leans the other way, but caries a potential risk of relapse.

A sad fact of the cancer journey is that we have no absolute way of knowing which choice is best; we cannot know if what we choose will be effective, making one choice may eliminate the other choices and often there are no "do-overs." There is a lot of compiled data on treatment decision-making, but we are individuals and data, like prognosis, applies only to groups of individuals.

A sincere talk with your medical team, understanding the variables, and after much pondering, should have you arriving at an acceptable choice.

meeshbmore

My husband has a mix of aggressive and indolent. We are told aggressive it often eradicated with chemo

for the 4 vs 6 cycle scenario, here is how it was explained to us / its a logarithmic equation which each treatment wiping out the same amount just smaller

example 1 million cancer cells and the treatments get 90% each time

cycle 1 - 900k killed. 100 k remain

cycle 2 90 k killed. 10 k remain

cycle 3 - 9 k killed 1 k remain

Cycle 4- 900 killed 100 remain

cycle 5 90 killed 10 remain

Cycle 6 - 9 killed. 1 remains so 1/1,000,000

we asked the same type of question because what is the risk/reward of continuing to wrack your body with poison if it’s such a small amount left.

I am interested in the research as well. Thanks for bringing it up and thoughts are with you

po18guy

Treatment is now less toxic and more effective than ever, so concerns are less. The problem is that 1 million cancer cells are (were) the threshold of detection by scanning. Even a single cancer cell, if not stopped, means you are soon back to stage IV. So, this is a fight for life. We all end up damaged goods - the walking wounded in the war. The damage we receive is what I refer to as the cost of living.

Since lymphomas are known for relapsing, and since the drugs used before may not be effective the second time (the living cells have defeats the prior treatments), we have to make the decision to keep fighting or surrender. Since cancer cells have unstable DNA, thy are known to "mutate around" the therapy - we end up breeding more potent, more virulent cancer cells unless we can kill enough that your weakened immune system can kill the rest.

And there is the rub. The fact that we have cancer indicates that, at some level, our immune systems have failed. Not completely, but to the point where they were overcome by the sheer number of mutated cancer cells. You are being seen at a world-class facility. They have the best of the best and may even offer a clinical trial. I am a strong proponent of clinical trials, having been in four of them.

These are not easy times, but mom said there would be days like this. Still, one day at a time, we get through it.