Please clarify growth hormone (GH) use after lymphoma. You mentioned in an earlier respone that you do not recommend GH for your non-Hodgkin's lymphoma patients becuse you feel it may create tumors. What if a patient is wasting? Would you limit the dose or not have the patient on GH at all. I had lymphoma twice and was treated with EPOCH (this is an intense chemotherapy regimen) first time (2 yrs ago) and most recently EPOCH & Rituxan plus radiation. I have since recovered however, my CD4 is one and vl 155,000 which is good for me becuase my VL has always been very high. I have never achived a good response to protease inhibitors but this is the first time my cd4 has been this low. I feel great but I lost 20 lbs during my treatment. I have recovered most of my weight, However, I wanted to stay on growth hormone for a while longer 6mg once a week. Do you think I should discontinue growth hormone altogether? My doctor does not like me on it, however, she allows me free rein on my treatment options (maybe good or bad). Please advise.

I, in general, do not use growth hormone in my cancer patients because of the concern that it could create tumors. The most important order of the day for you (as I see it) is to do everything humanly possible to ensure that your lymphoma does not come back a third time. The most important way to do this is to be on anti-HIV drugs which maximally suppress your viral load. Sometimes patients don't respond to their HIV medications, so complete suppression of the viral load is not always possible. The next most important way to prevent lymphoma recurrence is to avoid anything that could possible contribute to tumors. Growth hormone could potentially contribute to tumor growth. You did ask for my advice-- I would advise you to discontinue growth hormone altogether.

As for your physician's approach of giving you free rein-- My take on this situation is that your doctor gave you her best opinion, which is what she indeed should have done, and that she wanted to avoid overly confronting you over the growth hormone issue. This is exactly my own style in my practice. I give my patients my best advice, but then I too tend to avoid confrontation. (I'm sure I'll hear from my own patients who read this column as to whether what I write is what I practice.)