Dear Dr. Dezube, My mother was dignosed as having aggressive diffuse large B-cell lymphoma about three months ago in china, at the age of 54.

Her WBC has remained low for approximatly 20 years. Usually, it is approximately 3500/mm3, but sometimes may reduce to only 1500~2500/mm3 in some cases.

A recent Report of Pathological Diagnosis of Bone Marrow shows: No obvious abnormalities in 3 lineages of leukocytes; No increase in reticular fibrocytes; No tumor invasion to bone marrow is found.

After the first cycle of chemotherapy, her white blood count fell sharply to 800/mm3. Although it increased to 6000/mm3 after three-day injection of rhG-CSF (neupogen) (150 microgram per day), we are still concerned about whether additional chemotherapy might reduce the WBC to an even lower level such that rhG_CSF cannot help any more.

Fortunately, my mother had successfully get through the 1st chemo cycle, and her health condition seems much better than we expected. But what we didn't expect is, except for 1.2g Cyclophosphamide injection on the first day of second chemo cycle, doctors will not give my mother additional treatment and persuaded her to leave hospital and no other treatment any more. Their reason is the low count of white blood cell, although my mother's WBC remains 6600-4300 after this second cycle by accepting rhG-CSF. However, as all the medical material on lymphoma indicates, for this type of cancer, either delay of treatment or reduction of drug dose may severely reduce the possibility of cure and life expectancy. So we are really worried about this situation and feel helpless.

So we really hope to be able to have your second opinion on my mother's treatment or any advice. Is my mother really in such a situation that she must stop treatment? If she get additional chemo, what's the potential risk? Is any chemo medicine or rhG-CSF going to endanger her life? What's the precaution during the treatment?

Please, please help my mother, if possible.

Sorry to bother you so much with so many questions. Thank you.

Given the natural history of your mother's lymphoma, it would be best if she could get more treatment. If she does not, it is likely that the lymphoma will progress. Often it is necessary to lower the chemotherapy dose by 25%. Sometimes this reduction in dose is inevitable. The 25% reduced dose still does quite well (25% reduction means that she will get a 75% dose). In addition neupogen (rhG-CSF) should be given since it sounds like your mother responds to it. The combination of reduced dose and neupogen often works quite well. Much depends upon what your mother's wishes are. What does she want to do?