Pleural Effusion - please suggest

ashsaj
ashsaj Member Posts: 23
in Lymphoma (Hodgkin and Non-Hodgkin) #1

Hi, I Have a query - can anyone please suggest, is this happen in such scenarios?
My father being diagnosed of advanced NHL - large mediastinal mass and skeletal involvement , went through 2 cycles of chemo - R-CHOP. 
this week was his third week of 2nd cycle - his next one is due on 31st Oct. Last tuesday night he has been feeling severe chest tightness , shortness of breath and tachycardia. 
We went to ER - doc kept him in ICU - didnt provide any meds as he was stable except for pulse rate of 134 .
The diagnosis continues and in ultrasound of lungs its been diagnosed that he has gross plueral effusion - in right lung of approx more that a Litre. and left lung containing 376 ML of fluid. 
Yesterday they perform a procedure to extract the fluid. He is feeling much better and himself again - Coughing is still there with no mucus or anything. 
They have sent the fluid to labs for further examination. 
Initially before diagnosis he has the same fluid - examination suggested that it contains Atypical lymphoids , but then docs didnt pay much attention. 
But now they seemed concern - although they didnt tell us anything so far - 
I am hell concerend and worried - Does plueral effusion with lyphoid cells means you have lung cancer as well? 

 

Regards,

Ayesha

Comments

  • po18guy
    po18guy Member Posts: 1,505 Member
    #2
    No, it does not

    Some lymphomas are known for pleural effusion. Angioimmunoblastic T-Cell Lymphoma (AITL) is known for pleural effusion. At this point, I would wonder about the pathology on his biopsy sample, as AITL tumors contain both malignant T-Cells as well as abnormal (non-malignant) B-Cells, and confuse many pathologists. Just a possibility.

  • ashsaj
    ashsaj Member Posts: 23
    #3
    po18guy said:

    No, it does not

    Some lymphomas are known for pleural effusion. Angioimmunoblastic T-Cell Lymphoma (AITL) is known for pleural effusion. At this point, I would wonder about the pathology on his biopsy sample, as AITL tumors contain both malignant T-Cells as well as abnormal (non-malignant) B-Cells, and confuse many pathologists. Just a possibility.

    DLBCL

    Its Diffuse Large B-Cell lymphoma - inital fluid pathological tests revealed there are few atypical lymphoids found in the fluid. 

    after 2 chemos - when the fluid increased, they drained but now docs seems more concerned. Will this effusion or findings change the procedure of treatment? or chemotherapy ?? 

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,817 Member
    #4
    ashsaj said:

    DLBCL

    Its Diffuse Large B-Cell lymphoma - inital fluid pathological tests revealed there are few atypical lymphoids found in the fluid. 

    after 2 chemos - when the fluid increased, they drained but now docs seems more concerned. Will this effusion or findings change the procedure of treatment? or chemotherapy ?? 

    Sometimes

    ashsaj

    The chemo drug Bleomycin is sometimes given for pleural effusion.  Bleomycin itself is harsh.  ONLY your oncologist can determine if it would be suitable for him.

    It may be that periodic draining is itself better and less stressful than Bleomycin.

    I would doubt that this fluid accumilation will cause any change in his chemo schedule.  Killing the cancer is a priority over managable side-effects, regardless of what they are caused by.  Drainable fluid won't kill him.  But Diffuse B-Cell NHL if not stopped IS fatal-- think of the situation that way.

    Recall that as always we are not doctors here, and we cannot recommend medical treatments.   I am just sharing a fact in the public domain about a drug that is relevant to the situation that you enquired about. I hope it proves helpful to the two of you,

    max

    See section "What Bleomycin is used for."     http://chemocare.com/chemotherapy/drug-info/bleomycin.aspx

  • lindary
    lindary Member Posts: 711 Member
    #5
    ashsaj said:

    DLBCL

    Its Diffuse Large B-Cell lymphoma - inital fluid pathological tests revealed there are few atypical lymphoids found in the fluid. 

    after 2 chemos - when the fluid increased, they drained but now docs seems more concerned. Will this effusion or findings change the procedure of treatment? or chemotherapy ?? 

    ayesha

    When I had my first CT scan they notice fluid around my right lung. The first time they pulled almost a liter of fluid out. It filled up again in less than 2 weeks. By then my PMP & Onc agree I needed a catheter put in so we could drain the fluid at home. They got almot 2 liters when they did the procedure. This was done before the chemo started. The cancer (follicular lymphoma) had caused the lymph system to stop draining the fluids out of the plureal sac. By my third round of R-Chop we were getting very little fluid out of the lung sac. The cath was removed around April. 

    My view on the situation was, if there are lymph nodes in the area they may act weird because of the lymphoma. 

  • anantven
    anantven Member Posts: 11
    #6
    po18guy said:

    No, it does not

    Some lymphomas are known for pleural effusion. Angioimmunoblastic T-Cell Lymphoma (AITL) is known for pleural effusion. At this point, I would wonder about the pathology on his biopsy sample, as AITL tumors contain both malignant T-Cells as well as abnormal (non-malignant) B-Cells, and confuse many pathologists. Just a possibility.

    My Dad

    I read above that the Angioblastic T Cell is the one that is known for pleural effusion but the pathology report came back at Peripheral T Cell. I have not seen it but will check.

    So does Peripheral T Cell cause this pleural effusion as well ?

    In our case, my dad as been diagnosed with Peripheral T Cell Lymphoma and he also has pleural effusion.  His effusion rate seems to have slowed down a bit after the chemo. For example, before chemo they drained his right lung and within 24 hours he accumulated 800 ml.

    He got his chemo on March 8th and today his rate is about 200-300 ml every 12 hours. 

    They have given him a lung tube to continuously drain his effusion.

    When can I expect this effusion to stop ?

  • po18guy
    po18guy Member Posts: 1,505 Member
    edited March 2018 #7
    anantven said:

    My Dad

    I read above that the Angioblastic T Cell is the one that is known for pleural effusion but the pathology report came back at Peripheral T Cell. I have not seen it but will check.

    So does Peripheral T Cell cause this pleural effusion as well ?

    In our case, my dad as been diagnosed with Peripheral T Cell Lymphoma and he also has pleural effusion.  His effusion rate seems to have slowed down a bit after the chemo. For example, before chemo they drained his right lung and within 24 hours he accumulated 800 ml.

    He got his chemo on March 8th and today his rate is about 200-300 ml every 12 hours. 

    They have given him a lung tube to continuously drain his effusion.

    When can I expect this effusion to stop ?

    PTCL-NOS and AITL can be very similar to one another

    "NOS" means that they do not know which sub-type it is. NOS is a catch-all category, and some lymphomas in that broad category are almost identiical to identified sub-types such as ALCL or AITL. I had PTCL-NOS in 2008, 2009 and 2013. Also in 2013, one of the "NOS" cells mutated into AITL and I was then fighting two sub-types. 

    AITL and those which are similar, are known for pleural effusion, even though I never experienced that. I did have arthritis-like joint pain, anemia, rash, arm and leg swelling and several other odd, auto-immune-like symptoms. AITL is unique in that it releases cytokines (proteins) which cause the body to attack itself. Here is some information regarding AITL. There are four identified sub-types even of AITL!

  • anantven
    anantven Member Posts: 11
    #8
    My Dad

    Dear Po18Guy:

    I really need your advice and might need to speak with you as well.  My dad as I mentioned earlier was diagnosed with T Cell NHL.  Peripheral sub-type and no further sub-typing has been revealed yet.

    My dad, 83 had his first chemo on March 8th, 2018 and was doing sort of OK. He still had his pleural effusion from his lungs. However, two days ago he suffered a medical shock. He has a few complications and had to be intubed in the ICU.  He is doing slightly better and we are praying for this improvement. Thrown in the mix though are the effects of the chemo including low hemoglobin, WBC and Neutrophil counts and so on.

    Given, his age, outcome of the first chemo etc., I am exploring ways and options.

    You had mentioned names of several drugs ?  Leaving alone the cost of the drugs, can the doctor say that the patient is reacting very negatively to the chemo and therefore 2nd chemo is not possible and hence I have to put him or her on drugs like the ones you had mentioned ?

    Is that doable ? Your advice and pointing us in the right direction would be greatly appreciated sir.

    His next chemo is not for 21 days so we have time and are hoping for his recovery.

    Thank You!

     

  • anantven
    anantven Member Posts: 11
    #9
    po18guy said:

    Consult with a specialist

    Time is of the essence. Therefore, the best that I can offer is that if you are in the states, to consult with a T-Cell specialist. The following is not an exhaustive list, but the best of the best T-Cell Lymphoma research specialists are given here at the site of the T-Cell Leukemia Lymphoma Foundation.

    I connect the dots. I am not a dot. I just try to connect them. 

    Due to dad's age, his options are limited, but the newer less toxic single agent drugs make sense in his case. If he is willing, a consult with a specialist is a phone call away.

    One Phone call for a Consult

    Dear Po18guy:

    Are you suggesting that I call anyone of the T-Cell Lymphoma specialists in the list you provided ? Or are you recommending any particular one. He is not in good shape now but I can do the research for him so that as he gets better, he can try these options.

    Appreciate.

    Yes we are Americans and we live in the US.

  • po18guy
    po18guy Member Posts: 1,505 Member
    #10
    anantven said:

    My Dad

    Dear Po18Guy:

    I really need your advice and might need to speak with you as well.  My dad as I mentioned earlier was diagnosed with T Cell NHL.  Peripheral sub-type and no further sub-typing has been revealed yet.

    My dad, 83 had his first chemo on March 8th, 2018 and was doing sort of OK. He still had his pleural effusion from his lungs. However, two days ago he suffered a medical shock. He has a few complications and had to be intubed in the ICU.  He is doing slightly better and we are praying for this improvement. Thrown in the mix though are the effects of the chemo including low hemoglobin, WBC and Neutrophil counts and so on.

    Given, his age, outcome of the first chemo etc., I am exploring ways and options.

    You had mentioned names of several drugs ?  Leaving alone the cost of the drugs, can the doctor say that the patient is reacting very negatively to the chemo and therefore 2nd chemo is not possible and hence I have to put him or her on drugs like the ones you had mentioned ?

    Is that doable ? Your advice and pointing us in the right direction would be greatly appreciated sir.

    His next chemo is not for 21 days so we have time and are hoping for his recovery.

    Thank You!

     

    Consult with a specialist

    Time is of the essence. Therefore, the best that I can offer is that if you are in the states, to consult with a T-Cell specialist. The following is not an exhaustive list, but the best of the best T-Cell Lymphoma research specialists are given here at the site of the T-Cell Leukemia Lymphoma Foundation.

    I connect the dots. I am not a dot. I just try to connect them. 

    Due to dad's age, his options are limited, but the newer less toxic single agent drugs make sense in his case. If he is willing, a consult with a specialist is a phone call away.

  • po18guy
    po18guy Member Posts: 1,505 Member
    #11
    anantven said:

    One Phone call for a Consult

    Dear Po18guy:

    Are you suggesting that I call anyone of the T-Cell Lymphoma specialists in the list you provided ? Or are you recommending any particular one. He is not in good shape now but I can do the research for him so that as he gets better, he can try these options.

    Appreciate.

    Yes we are Americans and we live in the US.

    He may only need to have his file reviewed

    I would make contact at the nearest center listed, if he would have to travel there for any reason. His file can be reviewed by any of them, and all are excellent.

Discussion Boards