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DLBCL not complete remission after 4 rounds of R-EPOCH

Posts: 1
Joined: May 2018



My husband 31 yo has been through 4 round of the DA-REPOCH. After a CT-scan, the doctor said one site is still visible (1.9cm dropped to 0.4cm now) although the others are not visible from the CT-SCAN. This does not meet the remission definition and thus she suggested to do another 4 round of treatment as opposed to the planned 6 rounds.


Does this happen to anyone? Not reach a complete remission and extend the treatment cycle? Has anyone done 8 cycle? We are little worried about the intense lengthy treatment will beat him down.

Posts: 11
Joined: Feb 2018

my scans were clear after 4 rounds but I was told at Duke to take 2 more rounds to be sure. That has worked for me. In remission2.5 years

Posts: 1
Joined: Sep 2018

I had six planned rounds of R-EPOCH for Diffuse Large B Cell NonHodgkin Lymphoma with double hit. The PTscan after round 2 showed masses (in liver and peritoneum)reduced. The PTscan after all rounds showed liver mass gone and reduction in peritoneum with no activity. CTscan shows mass but doesn't indicate activity so surprised they aren't using PTscans. My scans since treatment show remaining mass in peritoneum but presumably dead tissue since not lighting up. No one ever suggested additional rounds. I'm two years past treatment now. R-EPOCH can really hammer you but it can get the job done. Best wishes to you!

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3661
Joined: May 2012

Chemotherapy regimens are usually measured in cycles, but patients commonly refer to "rounds," which they relate to the real-world experiences they are going through. Sometimes a patient will mean a "cycle" when they say "round," and sometime they mean an infusion -- which is ordinarily half of a cycle.  Administration on differing days of the various durgs that constitute one infusion (plus and oral meds required) makes this even more confusing for many patients.

Duration (number of cycles) is usually determined before beginning treatment, based on Staging.  Early-stage disease (Stages I and II) commonly receive around 4 months worth of whichever treatment (the most common being ABVD, CHOP, and EPOCH), while "advanced" disease (defined as Stages III and IV) is usually planned for 6 months of infusions, unless there are atypical factors going in, like "bulky disease" or other issues.

PET is the ordinay scan for tracking effectivelness, but a CT is substituted by some doctors during long-term treatment. But a PET is almost universal in attempting to establish complete remission (CR).

If remission is achieved before all cycles are completed, almost all doctors will give any remainng planned cycles regardless, since this dramatically improves the liklihood of permanent remission.  Disease that is not in complete remission after all planned cycles are over (so-called Refractory Disease) require the doctor to rethink, and adding a few additional cycles if they show promise of working is a common decision.  Otherwise, a salvage therapy would have to be begun.


Posts: 315
Joined: Jul 2016

Thank you, Max, for the much-needed straightening-up of terminology.

I believe, however, that while a cycle of ABVD does include two infusions (one on day one, and one on day fifteen) per 28-day cycle, a 21-day cycle of R-CHOP (that's what I had) means just the one infusion on day one, plus five days of Prednisone (days one to five) and all the other goodies. 

On another topic, BTW, are we to read into your (very nice) profile pic that you are a Godfather of sorts ;-)?


Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3661
Joined: May 2012




No, I just like pizza, wine, and Ferraris.



Evarista's picture
Posts: 317
Joined: May 2017

From the start.  All six rounds completed.  CT scans after round 2 and round 4...Would have gone to 8 if indicated. Hang in there.

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