Hi doctor,
The patient is a 52 years old female. 25 days ago, core biopsy of retroperitoneal lymph node non-Hodgkin's mature B cell lymphoma diffusely positive for CD10, CD20, BCL6 and BCL12. Bone marrow biopsy showed erythroid hyperplasia with focal micronormoblastic maturation. She is suffering with bilateral pleural effusions. Repeated thoracentesis done and again pleural fluid formation causing breathlessness. ICD tube drain inserted seven days back. Two weeks ago, R-CHOP cycle 1 chemotherapy was given, but no response or effect seen as there was no drop in blood counts nor any side effects. Our doubt is whether chemo R-CHOP cycle 1 shown effect inside the body or not? If not can we give R-CHOP chemo cycle 2 after 14 days instead of 21 days. PET-CT shows metabolically active nodal disease above and below the diaphragm, in abdomen, mediastinal lymphadenopathy and at neck. Pleural fluid cytology is positive with atypical lymphoid cells, atypical large cells in clusters scattered singly and round with scant amount of cytoplasm and round nucleus with coarse chromatin. Does it mean malignant pleural effusion? After removal of ICD tube drain, is pleurodesis compulsory or not? If pleurodesis is required, then please suggest regarding talc pleurodesis. Also, do we need to consult any special surgeon for pleurodesis or general surgeon sufficient?
Hello,
Welcome to icliniq.com.
Thank you very much for being specific in what you want to ask.
- For lymphoma associated effusion, we do not suggest pleurodesis (procedure to remove excess fluid in pleural space) as most of the patient responds to chemotherapy.
- One cycle is a short time to know if there is a response. Moreover, only 12 days have passed. So, wait till the chemotherapy works. May go for tapping once again. If it is really not responding then only think of pleurodesis.
- Yes, biweekly CHOP has tried and is found to be more effective (Cyclophosphamide, Doxorubicin, Vincristine and Prednisone). But, it is yet not into guidelines. So, it is not practiced or of trial setup. Discuss with your oncologist because he has to take the responsibility to give it.
- Also, can you reply with the dose utilized and GCSF (granulocyte-colony stimulating factor) support given or not?
Revert back with the answers to the above questions to a medical oncologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-oncologist
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