Treatment

I followed the protocol set forth in Blood. 2002 Apr 15;99(8):2685-93, and had six cycles of dose adjusted REPOCH chemotherapy. Every three weeks from October, 2012 through February, 2013, I was admitted to the hospital on Monday and stayed through Saturday or Sunday. Although the chemotherapy took 96 hours, I always stayed one to two extra days to received continuous IV fluids because I was too sick to drink enough water during the first few days after chemo and the extra fluids really helped to prevent nausea. The necessity of staying these extra days was a lesson a learned the hard way after the first chemo cycle when wound up in the emergency room for dehydration.

After the base dose of chemo given during the first cycle, the dosage of chemo was increased 15%, but only 9% for the cyclophosphamide. The discrepancy in the dosing was due to rounding issues in the newly adopted electronic medical records system. For cycle three, the dosage of chemo was increased 10% for a total of 20% over the original dose in cycle one. For cycle four, the dosage of chemo was increased 20%. For cycle five, the dosage of chemo was increased 20%. For cycle six, the dosage of chemo remained the same as cycle five.

I received a PET scan after cycle four and it was read as a negative – complete metabolic response. The scan showed that the tumor had shrunk from just under 13 cm to two cm with a PET SUV of 2.4. The remaining 2 cm tissue was not active lymphoma. I received another PET scan after cycle six. The two cm spot was still present with an SUV between 2.3-2.4. The radiologist at the Cancer Epicenter of the South declared this negative. The radiologist in Oz declared this positive according to the Deauville Criteria.

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