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Non-Hodgkins Lymphoma: Chemo & Rituxan; Epstein-Barr Virus in my tumor.
Oct 13, 2002

Dr. Dezube, Thank you so much for answering my first question(posted August 29,2002),you have helped me so much. Im here to fill you in on my ongoing journey and once again ask your opinion. As you may remember I was contemplating the Chemo question in regards to battling this Lymphoma diagnosis. Well after a visit to two more great Oncologists (UNC-Chapel Hill & Duke respectfully), and getting a copy of the actual diagnosis from John Hopkins, which stated that "the proliferation rate approaches 50 consistent with high grade lymphoma" and further findings were: "large foci composed of sheets of large atypical lymphoid cells that are immunoreactive for CD20 and Bcl-2 antigen and negative for Bcl-6". The one finding that really made me sure of having Chemo done was: "EBV(Epstein-Barr Virus) in situ hybridization for EBV-encoded RNA, is strongly positive within the neoplastic population". I was informed that EBV positivity is frequently observed in HIV associated non-Hodgkins lymphomas. Well that made my decision, besides the fact my 3 Oncologists,plus yourself all recommended that I have this Lymphoma treated, after all you can't go wrong with UNC-CH, Duke, and Harvard weighing in with the same advice. Well in terms of my health I feel better than I have in years. I'm on a good diet, I work out 5 days a week, 40 minutes Cardio mixed with weight training and most importantly my lifesavers: Epivir/Zerit/Sustiva. My CD4 is 260 and climbing and my viral load has gone down to 70. My Oncologist said the same thing you said to me that I will sail through Chemo, which I strongly believe I will. He wants to put me on 4 cycles of C.H.O.P and Rituxan. What are your thoughts on this approach and would I have to get my Chemo in less strong dosages as is normally given. Also should I continue my oral ganciclovir(for my CMV) and will I be open to other infections with my reduced blood cell counts? These are all questions I will surely ask my Oncologist and my HIV specialist, but I value tremedously what you have to say. I cant tell you how great I feel and how sure that I will have a long and wonderfully healthy life.The most important thing that I can give to other people going through the same experience: is to keep a good and positive attitude, you will pull through all of this. Once again Dr. Dezube I want to say thank you. The service that The Body and doctors like yourself provide is invaluable to all of us.

Response from Dr. Dezube

Chemotherapy is not one of those things which life prepares you for. Rather the need for it often comes when you least expect it. I believe you have made the right choice. And you should do well. CHOP + rituxan is the right choice. I wish you well-- I have many patients out ten years or more from their chemotherapy and doing well.

As for the fact that you got 4 opinions, I only hope that future decisions won't be so complicated. Getting so many opinions can be paralyzing. Hopefully as you settle down into treatments, things will come to you abit easier.

As for the ganciclovir, it's hard for me to comment without knowing the specifics of your case. I can tell you that ganciclovir complicates chemotherapy quite a bit. Speak to your HIV specialist and see what s/he says.

One last thing, which I hope won't put too much a wrinkle into your plans, is related to the Epstein-Barr Virus found in your tumor. There was a recent medical article that showed these specific tumors (i.e. tumors with EBV) tend to spread to the spinal fluid. It is now recommended, based on that article in the Journal of Clinical Oncology, that you get 4 treatments of chemotherapy into the spine to prevent the tumor from spreading there. Many of my patients have received chemotherapy into the spine (via lumbar puncture/spinal tap) with great success.

GOOD LUCK!


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