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Is checking central nervous system critical?
Mar 2, 2001

Dear Dr. I was recently diagnosed with NHL (B, large cell.) My CD4 is 200 and viral load hovers around 8,000. The LYmphoma was found in a node under my arm and CT scan doesn't show any other signs of the disease. I have no other symptoms. I will be having a gallium scan later this week. My doctor did not order a spinal tap or brain scan because there didn't seem to be an indication that the lymphoma was in my central nervous system. Is this a safe assumption? Should I press her to do further tests to be sure? I will be starting CHOP next week. How important is it to get my viral load down further? I am presently on 3 drugs.(Zerit, Ziagen, Epivir) should I be pushing to add another drug or is this a bad time to make changes? I look forward to your opinion. HM

Response from Dr. Dezube

Dear HM: A spinal tap is part of the staging evaluation for HIV-related lymphoma. It should be done! I have performed a spinal tap on virtually 100% of my patients. The transient discomfort associated with a spinal tap pales compared to missing the diagnosis of spinal fluid involvement. In HIV-negative patients, such a spinal tap is typically not done. You also need a bone marrow examination. In addition to CHOP, I on occasion administer chemotherapy into the spinal column if the bone marrow is involved with lymphoma, if the tumor demonstrates evidence of the EBV virus, or under a few other circumstances. Now is NOT a good time to juggle your antiretroviral medications. If you have a side effect, you won't know if it's due to the chemotherapy or due to the anti-retrovirals. Also, although a viral load of 8000 is not optimal, it is also not all that high. So in short, complete the staging (bone marrow and spinal tap) and get 6 cycles of CHOP. Good luck. Please tell your oncologist that she can call me if he had questions. BD.


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