My mother recently was dx with Lg B Cell Lymphoma She was tx with R-Chop. She developed pneumonitis secondary to R-Chop. What are her tx options now? She is 79.

I have been told that R-Chop was the "cure" and now all other tx options will only keep the lymphoma from worsening. Is that correct? Has anyone else had a pneumonitis side effect from R-Chop? Would a reduced amount of R-Chop be a consideration? We meet with the oncologist in 2 weeks. Her last tx was Dec. 20 with R-Chop. The plan was to reduce the tx down to 75% in January, however she was not able to receive tx due to the lung reaction. I have been told that this side effect for R-Chop is rare. Could it have been avoided with a lower dose of R-Chop from the start?

That is a very rare side effect of R-CHOP, yes. I think most would expect cardiac issues before pulmonary issues. I don't know if anyone can tell you whether a lower dose would have avoided the pneumonitis; I doubt anyone could say that with any certainty.

That said, R-CHOP is right now considered the top-line therapy for that subtype, and it is said to result in a 'cure' a good percentage of the time. It is not the only chemo option for your mom's subtype, but if R-CHOP is indeed the cause of her pneumonitis, that's problematic because none of the drugs in that regimen are known for causing lung problems. Second-line options include regimens known as DHAP, ESHAP, GemOx, and CEPP, but these come with their own caveats.

It would seem that your mom had some pulmonary predisposition that maybe facilitated the onset of pneumonitis? I guess I would maybe want to get a pulmonologist on board with the oncology team to see what might work best?

Ross