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Nasser:
Did you undergo the CHOP regimen, or maybe PMitCEBO? My understanding of T-cell lymphomas is that they don't respond all that well to CHOP. Regardless, sometimes chemo can cure a patient with PTCL or at least make it run for cover for a while; however, generally speaking, prognosis is not outstanding with most t-cell lymphomas unless they're treated with HDTC (high-dose chemo) and, often, a bone marrow transplant (as this study indicates, although it looked at patients with recurrence).
As you obviously know, the hemo count and LDH levels are important tests, and I'm assuming that prior to chemo these levels weren't normal so that much is good. Nonetheless, since aggressive chemo is often necessary for PTCL I would think that, if your doctors are saying 8 cycles then 8 cycles is what you should undergo, even though 6-8 is generally what the treatment protocol calls for.
Regarding prognosis, I can't find anything that I feel comfortable citing, but I will continue to look.
Ross
Nasser:
I came across a study out of Fukuoka University's Department of Internal Medicine. While it didn't give specifics about prognosis, it did say that the factors it considered to be significant prognostic factors in terms of overall survival in T-cell lymphomas are:
Presence of B symptoms
Platelet count <150 x 10(9)/l
International Prognostic Index (IPI)
However, it then said "Multivariate analysis indicated that only the IPI was an independent predictor of OS (overall survival)."
In case you're not familiar with how the IPI works:
Give one point for each of the risk factors:
Patient is over 60 years old (you're 45, no point here)
Lymphoma is in Stage III or Stage IV (don't know)
LDH levels are elevated (yours are normal, no point here)
ECOG/Zubrod performance status: 2, 3, or 4 (you're asymptomatic so your performance status is 0, no point here)
More than 1 extranodal site (don't know)
Add up the points:
0-1 points: Low risk. 5-year survival- 73%
2 points: Low-intermediate risk. 5-year survival- 51%
3 points: High-intermediate risk. 5-year survival- 43%
4-5 points: High risk. 5-year survival- 26%
Based only on what you've said, you can't possible have more than 2 points, putting you in the second category, low-intermediate risk. If you were diagnosed in Stage I or II, or if your cancer had not reached more than 1 extranodal site, you automatically bump up to the best category, the low risk category.
Ross
Source:
The International Prognostic Index predicts outcome in aggressive adult T-cell leukemia/lymphoma: analysis of 126 patients from the International Peripheral T-Cell Lymphoma Project. Annals of Oncology, 2009;20(4):715-21).
Many thanks dear Ross for your detailed response. I have been treated with CHOP protocol every 14 days. Though I was stage III at the time of the diagnosis , with no extra nodal involvement , but I've been asymptomatic since the first chemo cycle, also LDH back to normal afetr the 5th cycle , and I've already regained my pre sickness weight. So I assume I'm in low risk group (hopefully !)
I'm really worried about the effectiveness of CHOP and I don't know whether it is possible to shift to any other protocol at this stage ! Also I wonder if it is wise to go for BM transplant during the first remission ;or shall I wait for relapse then consider transplant ; please adivse.
Best regrads
Nasser
Nasser—
Yes, according to the IPI, you fall into the lowest risk category, the only point you earn is having been stage III. Of course these are numbers, statistics- they do more for statisticians and epidemiologists than they do for the actual people who make them up. That said, the implication for you is as good as it can be according to those numbers.
Regarding CHOP, as we talked about earlier, the CHOP regimen does not have a great track record with the likes of PTCL. Furthermore, two drugs in the CHOP regimen- the cyclophosphamide and the doxorubicin- can have particularly nasty side-effects. I do understand your concerns about the effectiveness of CHOP but from everything you've said so far, this chemo regimen seems to be working for you.
It's certainly not unheard-of to change chemo regimens, but the problem is …. change to what? CHOP is as close as it comes to a standard chemotherapeutical response to PTCL. There aren't a lot of published, peer-reviewed studies on other regimens that suggest other ones might work.
There is this study from 2004 which looked at the effectiveness of the EPOCH regimen ("doxorubicin/epirubicin, vincristine, etoposide over 96 hours' infusion with bolus cyclophosphamide, and oral prednisone") for PTCL, and concluded that it was "effective" and well-tolerated by PTCL patients. Yet there's very little difference, drug-wise, between these two regimens; the only difference is the addition of etoposide to EPOCH.
As for a bone marrow transplant, it may seem like a somewhat common procedure but there are still considerable risks associated with it. A transplant during the first remission doesn't make sense to me, since the goal of such a transplant is to treat your cancer, and in remission you would have little to no manifest trace of cancer or its symptoms. In the case of PTCL, it's typically combined with high-dose chemotherapy, but (at least in the case of autologous transplantation, in which the marrow is removed from your body before the high-dose chemo cycles) the procedure starts BEFORE the chemo. Thus, at relapse seems the more reasonable time to consider such a procedure, but let's hope you don't have to consider it for a very long time, if ever.
If your PTCL does relapse, I would imagine that your doctors would recommend the transplant plus high-dose chemo, since that seems to be the treatment of choice for relapsed or refractory PTCL (and yours doesn't seem to be refractory so far).
Hope this helps you to bring your concerns to your doctor(s) armed with additional information.
Ross
Dear Ross ,
Many thanks for your informative and detailed answer. Two days ago I’ve undergone PET scan for the whole body in which it revealed total resolution of the supra phrenic disease without any detectable SUV , while in the sub phrenic area there is one lymph node in the lower left mesenteric area ,about 11 mm in diameter with SUV=2, this same node ,two months ago, was 13mm in diameter with SUV =2.2. My oncologist said this is reactive lymph node and no need to worry about it !
I wonder what is the normal value of SUV in PET scan ?
While having such lymph node with SUV =2 , after 6 cycle of CHOP14 dose it mean successful treatment and complete remission; or it means that there is minimal residual disease that requires more intervention ? Please advise
Many thanks for your usual indispensable guidance and support
Nasser
Nasser,
A friend of mine will be starting her first round of chemo this week and as she has a large family I would like to offer her some support and comfort without disturbing her rest. What did you find comforting when you were going through chemo treatments?
Thanks,
friend2u
Nasser,
Can i please ask if you had High Dose Chemo for your treatment or was it the intermedite dose?
Regards
sam