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When is enough lymphoma treatment enough?
Feb 21, 2003

Back in August I had a 6 cm mass on my neck that was growing very quickly. It was diagnosed as NHL -- diffuse large B cell. Three weeks ago I completed 6 rounds of chemo and Rituxan. The tumor disappeared after the first treatment. (Incidentally, I took a 60 day break between the 3rd and 4th treatments while running around to meet radiation oncologists -- I ultimately deciding against radiation.) I feel good and weathered the chemo relatively well although my blood counts are worrisome right now. WBC 2890 and NEU 22%. My question to you is...should I do two more rounds of Rituxan or is this overkill? Is 8 treatments standard? If so, based on what? How hard is Rituxan on the immune system? Especially MY immune system given my numbers? What would you do if it was your body? Thanks so much for your input and your ongoing commitment to our community.

Response from Dr. Dezube

You ask an excellent question. Most oncologists give 6 cycles of chemotherapy. Many patients are then faced with a difficult decision, should they get a little more or is it "enough is enough". The first thing to say is that there are NO government guidelines to follow, so please realize that I will give you my opinion, but it is nothing more than an opinion. Many, if not most, AIDS oncologists participated in a government trial which explored the use of 6 cycles of CHOP-rituxan followed by 3 treatments of rituxan. Since many of us are comfortable with that approach, we tend to use it.

HOWEVER, you raise the concern that Rituxan may be hard on the immune system. This is a valid concern since rituxan attacks lymphocytes.

What would I do? In my most recently treated patients, I did indeed treat with CHOP-rituxan for 6 cyles, followed by rituxan alone every three weeks for 2-3 more doses. In a patient who was particularly fragile, I probably would not give that extra Rituxan. Although you say that your blood counts are worrisome, I doubt rituxan would make the situation worse. If you were my own patient, I would indeed recommend 2 more rituxan treatments, but alas, to quote you, such treatment is probably "overkill". You'll probably be okay each way.

I'd be curious to know what you end up deciding.

Each day I see another sunrise
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