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Is it safe to continue CHOP? anal fissure
Mar 1, 2001

After just my first CHOP treatment for NHL I got an anal fissure. We have had to stop treatment because my oncologist is fearful of me getting an infection. In the meantime I have done a four week round of Rituxan. Do you think it would be safe to start up with CHOP again? (there is no longer bleeding although my butt doesn't feel normal yet.) I understand that sometimes these things can take months to heal -- what then? I want to get this CHOP over with but I also don't want to do myself in with the treatment! I am very fearful of continuing and equally fearful of not getting treatment. I don't know what to do. Any advice? Thanks for your help.

Response from Dr. Dezube

The bottom line is the HIV lymphoma is very aggressive and needs to be treated with CHOP; typically 6 cycles. I would favor proceeding with CHOP. How is your white cell count? It is vitally important that it be maintained in the high range since this will promote healing of your other bottom line (i.e. your butt). You may benefit from G-CSF; this agent will keep your white count in a robust range. I've had many patients in your exact situation. In all cases, we proceeded with CHOP. In a few cases, when the fissures or abscesses were particularly bad (and this may be the case with you), I gave the patient half-dose CHOP for a cycle or two. Half-dose CHOP (believe it or not) works almost as good as full dose CHOP. I predict (but can't guarantee) you'll do well if the fissure is your only problem. I'm not trying to minimize the fissure since it certainly can be painful. Good luck. BD.


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