History of My Lymphoma - Part 1

As of this writing (October 31, 2005) I am suffering from large B-cell diffuse lymphoma. This is the second time I’ve had this exact type of Lymphoma – the first time was 15 years ago in June, 1990 when I lived in New York City (I now live in Denver). At that time a tumor was visible in the left side of my neck. My treatment was 6 cycles of a chemotherapy called CHOP and 20 hits of local radiation to the neck. I finished CHOP in October of 1990 and finished with radiation in January, 1991.

The treatment seemed to have cured me but then in June, 2005 I was diagnosed with large B-cell diffuse lymphoma again. This time I had a couple of tumors in the rear of the abdomen (retro-peritoneal area). They were discovered because they were pressing up against my intestines and causing an intestinal blockage.

Typically a relapse of Lymphoma happens after two or three years, not 15 years. The doctor's therefore did not know whether to treat this as a new Lymphoma or a relapse of the original Lymphoma. The treatment of choice for this type of Lymphoma, if new, is CHOP chemotherapy. The treatment of choice for a relapse of this type of Lymphoma is salvage chemotherapy followed by a stem cell transplant.

My doctor in Denver chose to treat this occurence of Lymphoma as a new Lymphoma since it had shown up after 15 years and had also shown up in a new location. Starting in June, 2005 through September, 2005 I had four cycles of R-CHOP. The R in R-CHOP is Rituxan a monoclonal antibody developed by Genentech in 1997.

From the Genentech web site: Rituxan works by binding to a particular protein (the CD20 antigen) on the surface of normal and malignant B-cells. From there, it recruits the body's natural defenses to attack and kill the marked B-cells. Stem cells (B-cell progenitors) in bone marrow lack the CD20 antigen, allowing healthy B-cells to regenerate after treatment and return to normal levels within several months.

I had a PET/CT scan on Monday, October 3rd with the understanding that if the scan showed I was in complete remission that I would likely continue with two more cycles of R-CHOP. If not in complete remission then I would most likely go to a salvage therapy and a stem cell transplant.

The results of the Oct. 3rd PET/CT came back showing some “small mild residual activity” with an SUV score around 3. A PET scan shows metabolic activity typical of a malignancy. An SUV score shows the level of activity. When first diagnosed with this Lymphoma in June, 2005 I had an SUV score of 20; an SUV score of around or under 2 is indicative that there is likely no malignant activity.

Since I had an SUV score of 3.8, I was not in complete remission after 4 cycles of R-CHOP and a stem cell transplant was indicated.

More to come in Part 2.