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Is halving CHOP dose still effective?
Mar 2, 2001

Dear Doc, I would really appreciate a second opinion here. I had my first treatment for stage 2 NHL and ended up in the hospital on day 9, feverish and neutropenic (WBC 1.3) I had been using neupogen from day 6-16. When I left the hospital 3 days later my white counts were up to 5. At the same time I started to have problems with my rectum (which we finally found out two days ago is herpes.) In the meantime, when I went to go back for my next CHOP, at 3 weeks my white count was only 2.3. We pushed treatment off another week and WBC count was only 2.7. (Between the low counts and unidentified infection it was not prudent to go ahead with chemo. ) I am now scheduled to have my second CHOP treatment at 6 weeks and my oncologist is planning on reducing the dose to 50. Three questions: 1) Have I completely jeopardized the effectiveness of treatment by waiting this long (6 weeks) between doses? 2) Given my counts staying down would you half the CHOP or would just starting the neupogen earlier(which she is planning on doing anyway -- starting day 2 and continuing for 2 weeks)? I want to survive the chemo and not have it do me in but I also want the chemo to be effective; 3) Any suggestions as to why the counts are staying so low? (mine are normally around 4.7) She is also going to put me on Cipro as a preventative which Im not thrilled with. Any suggestions? Thanks, once again, for your help.

Response from Dr. Dezube

Half-dose CHOP is indeed quite effective. Prior to the advent of the protease inhibitor era, half-dose CHOP was the standard of care for AIDS-related lymphoma. Since the advent of protease inhibitors, full-dose CHOP is now the standard. I do NOT feel that you have "completely jeopardized" your chances. Many, many of my long term survivors have received only half-dose CHOP. It is more important during treatment and post treatment, what your viral load is. The lower it is, the better your chances that your lymphoma will not return. G-CSF (neupogen) works much better if it is given starting on day 3. I would probably recommend that you get 50% chemo this cycle as you are planning and starting G-CSF on day 3. If you sail through this cycle, and I predict you will, then on the next cycle I would give you a 75% dose. If you tolerate the 75% dose, then on the next cycle, I would go back to 100%. You clearly understand the delicate balance of getting as much chemo as possible in you without jeopardizing your health. Good luck. BD.

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