Can my lymphoma relapse after following RCHOP and Methotrexate treatment?

Question

Hello doctor,

I wanted to give you an update on my health. Seven months ago, I was diagnosed with stage 4 NHL - Diffuse Large B Cell Lymphoma. I had no history of any bad habits, high blood pressure, or diabetes before this. After the diagnosis, I had a bone marrow biopsy and a PET CT to determine how bad things were. I started getting RCHOP treatment, which included six rounds and two rounds of high-dose Methotrexate. After three rounds of RCHOP, another PET CT showed no bad stuff with no FDG uptake or SUV activity, which was great news. A month ago, I finished all eight rounds of chemotherapy, following my doctor's advice. I was told to wait a month before doing another PET CT to see how things were going. However, the recent PET CT showed a swollen mesenteric lymph node with some SUV activity. I am feeling pretty down about it, especially after no SUV activity. Recently, my doctor did a biopsy on the mesenteric lymph node. I have attached the reports for you to see. I have some questions. I would appreciate your thoughts on

Was my treatment plan of the six rounds of RCHOP and two rounds of Methotrexate right for me?
How is it possible for the lymphoma to come back so soon after I finished all my chemotherapy? What is the next plan, considering I have been on treatment for seven months?
Since DLBCL is a severe type of cancer, how successful is the second-line treatment likely to be if I go for it?
If I decide not to do any more treatment, could you give me an idea of what might happen to my health and how much time I might have?

I am grateful for your help and advice during this tough time.

Thank you.

Answer 1

Hi,

Welcome to Icliniq.com.

I have read your query and understand your concern.

Here are the responses to your questions:

RCHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Vincristine, Prednisone) treatment is the current standard and effective therapy.
Lymphoma relapses are uncommon but not unexpected.
The recommendation is to undergo additional cycles of RCHOP.
Success rates for treating relapsed lymphomas are promising.
Opting out of relapsed lymphoma therapy could pose life-threatening risks within six months.

However, the conclusive histopathology report to confirm a relapse is pending. Kindly share the report once it is available. I hope this helps. Please revert in case of other queries.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern. Here are the answers to your questions:

Yes, the suggestion to repeat RCHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Vincristine, Prednisone) treatment means using the same RCHOP medications as before.
No, radiation therapy is not recommended at this point.
The number of cycles for the repeated treatment will depend on the findings from the biopsy report.

I hope this helps. Please revert in case of further queries.

Thank you.

Answer 3

hi . welcome back. report came back normal. there's no evidence of lymphoma in the tissue processed. but the tissue submitted for histopathology was too tiny. in my opinion, a larger tissue piece or full node biopsy should be taken to definitely rule out any pathology. in addition, get ESR, CRP, beta 2 microglobulin level done for some biochemical evidence of the absence of a pathology.