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Non-Hodkins Lymphoma Burkitts-like recurrence; Is it too late?
May 26, 2002

My father was diagnosed with non-Hodgkin's lymphoma Burkitts-like) about a month and a half ago. They did an HIV test at the time because his immune system was so low and found that he was positive. My father is 78 and has been married to my mother for over 50 years. They are not sure how he got it. Any idea how long it could have been in his system? Prior to being diagnosed they had removed a large tumor from under his arm. They admitted him to the hospital and started aggressive chemotherapy (CHOP) and rituxan. They had sent him home from the hospital and had planned to do several follow up chemo treatments 3 weeks apart. They have given him no HIV drugs, saying they wanted to treat the cancer first. He had to be readmitted to the hospital 2 weeks ago because he was experiencing dizziness and double vision. After a spinal tap, they discovered he had cancer in his spinal fluid. They did more chemotherapy (via syringe) and put a shunt into his head. He also received radiation therapy. Everything seemed to be going well...the cancer was going away, but now the original tumor seems to be back. The doctor gave him another round of rituxan and plans to give him 3 consecutive days of aggressive chemo. He has told us that this is the strongest chemo he can give and because this is a recurrance that if it doesn't work that there isn't much more that can be done. I read a previous question you answered that was posted Jun 2, 2001 in which you state that it is vitally important that the patient start HIV meds. That it is the best assurance that his tumor will go away and stay away. What do you think now? should he be on HIV meds? Is it too late? Please respond. Concerned daughter

Response from Dr. Dezube

Dear concerned daughter: I'm sorry to hear about your dad's tumor and the fact that it recurred. Clearly the presence of tumor cells in the spinal fluid is a very serious complication from the cancer. Also as your note implies, it is always harder to treat the lymphoma when it recurs. Is it too late? We can hope that your dad will respond to another round of chemotherapy. On occasion patients do indeed response nicely the second time around. Your father's case is difficult, indeed very difficult, but it is not hopeless. Should you father be on HIV meds? In my own practice, I do treat my HIV-lymphoma patients with HIV meds. This does not mean that all oncologists do so. I can only tell you what my style is. Your father's HIV doctor and his oncologist will need to work together to sort that issue out. I'm touched by your concern for him. Please write back and let me know how he does.

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