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New diagnosis of lymphoma; How should I be treated?; What about naturopathic regimen?
Sep 16, 2001

I was diagnosed yesterday with B-cell lymohoma in AIDS that appears to be in Stage 1. I noticed a lump under my right arm, which has since doubled in size. I have no other symptoms (night sweats, etc). I tested HIV+ 3 years ago. I am on no medication and have maintained a viral load in the 5,000 to 10,000 range and CD4 count in the 400 to 450 range.

What treatment would you recommend for the lymphoma? The doctors performed a CT scan, biopsy of the tumor and a chest x-ray. Would you recommend any other tests?

I have been practicing a naturopathic regimen since 99. Would you recommend I start meds at this time or after treatment to prevent reoccurance?

Thanks for your help!!

Response from Dr. Dezube

Getting a cancer diagnosis is always difficult, no matter what the setting is. AIDS related lymphoma is VERY treatable. With you relatively high CD4 count and relatively low viral load, you should do okay. Without knowing many of the specifics of your case, it's hard to give a more definitive prognosis. It's important to stay as upbeat as possible.

The staging and treatment of AIDS related lymphoma entails the following: STAGING (all of these are very important)

1) You mention you had CT scans; you should have a CT scan of the chest, abdomen, and pelvis (some places call such a scan a torso CT)

2) bone marrow biopsy

3) gallium scan

4) lumbar puncture (spinal tap)

TREATMENT

1) The standard treatment is CHOP chemotherapy, though occasionally you will find oncologists will use other regimens. Typically 6 rounds (cycles) of chemotherapy are given. Though certainly not a "walk in the park", this chemotherapy is tolerable by most patients.

2) ALL patients getting lymphoma chemotherapy should get PCP prophylaxis regardless of the CD4 count

3) Virtually all patients with lymphoma should be on a good HIV regimen. In the setting of lymphoma, I personally prescribe a regimen of zerit/epvir/sustiva since this regimen does not interfere with chemotherapy. Avoid AZT (retrovir) since this does interefere with chemotherapy.

4) In the unlikely event that your tumor has spread to your spinal fluid, the treatment is VERY different. Write back to me if such a situation has occurred in your case.

5) Many patients with HIV receive Neupogen (G-CSF), a medication which prevents the white count from going too low.

6) TLC (tender loving care)- It really is important that you call in all your supports. It's tough to go through treatments alone. Hopefully you'll get abundant supplies from your oncologist, nurse, friends, families, social workers, primary physician, and so on.

7) Lastly open lines of communication are very important. This would include communication between you and your oncologist/nurse/primary provider and so on, as well as communication between your oncologist and HIV provider and primary care provider.

As for the naturopathic regimens, I see no harm with them. However, since so little is known about how they interact with chemotherapy, I would recommend not taking any naturopathic remedies from one or two days before each chemotherapy session up to two or three days after each session.

GOOD LUCK.


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