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Diffuse Large B-Cell Lymphoma Diagnosis

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Published on July 22, 2020

What to Expect After a Diffuse Large B-Cell (DLBCL) Diagnosis

Diffuse large B-cell lymphoma (DLBCL ) is a rare and aggressive form of non-hodgkin lymphoma that is often responsive to treatment and for most patients, can be cured.
 
Lymphoma expert Dr. Erlene Seymour, Karmanos Cancer Institute and Patient Power co-founder, Andrew Schorr discuss step-by-step what most newly diagnosed DLBCL patients can expect from initial diagnosis, to testing and infusion treatment. They also discuss how age can make a difference to treatment options for DLBCL .
 
This is the final part of a 2 part series, watch Part 1 Understanding Diffuse Large B Cell Lymphoma (DLBCL).

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Transcript | Diffuse Large B-Cell Lymphoma Diagnosis

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

So, you make a diagnosis and then how do you know what treatment to do? How do you decide?

Dr. Seymour:

If you are newly diagnosed, I typically will get more genetic testing to see if you have any of these acquired mutations that may call you something like a double hit lymphoma. We do some testing to look at your chromosomes to see if they have abnormalities that suggest you have what we call a double hit lymphoma. Because if that were the case, we may choose a different type of chemotherapy. But otherwise, if you don't have any features that suggest that you have a more complicated, aggressive diffuse large B-cell lymphoma, most patients would get what we call R-CHOP. And that's a combination of chemotherapy with rituximab (Rituxan).

Andrew Schorr:

Okay. But you've been using R-CHOP since long before you went to medical school. Many, many years it's been around. People think, well, isn't there new stuff to do right away? Or is that just typically effective and often curative? And if it's not broken, don't fix it.

Dr. Seymour:

It has been very hard to beat R-CHOP, but I don't think that stops us from trying and particularly in those patients, like I said, they are more aggressive type, double hit lymphomas for instance. And another good example of that is in a Richter's transformation where you've actually transformed from a CLL or a follicular lymphoma. We know that those patients sometimes don't do well with just R-CHOP by itself. We are certainly still looking to see how we can improve upon R-CHOP. If we can add things to R-CHOP to make things work better. Particularly for patients who who tend to be more aggressive types of diffuse large B-cell.

Andrew Schorr:

Just to understand the logistics of it. If a patient is offered R-CHOP, that's all infused therapy. What does that mean today? How long does it go on? How often do they have an infusion? And what should their expectations be?

Dr. Seymour:

Typically we'll do up to six cycles. One cycle is three weeks, so three weeks to complete one cycle. But the way that actually looks to a patient in clinic is on day one of that cycle, you come in, you get infusions. You also take five days total of prednisone, high dose steroids. For some patients, although not all patients, for some patients we do also give you a shot of Neulasta or Neupogen on the second day after chemotherapy. And so what it looks like is a day of infusions and perhaps a trip back or a patch that's put on your shoulder. To help you keep your white blood cell count up and then you come and see us again in three weeks and repeat it again.

That gets repeated six times. About four and a half months of infusional therapy. But the nice thing about R-CHOP is that most of this is done outpatient so it's through an infusion center. We don't typically admit patients to the hospital to have that done, but it is a lot of travel for some folks. Sometimes I see patients who are traveling from very far away and getting it and that can be a little bit more difficult. However, this is a bread and butter chemotherapy so it's been given in a lot of different places.

Andrew Schorr:

Okay. And they're having frequent blood tests to see how things are going?

Dr. Seymour:

Often. Actually not so often with my patients. My practice is to, if I'm concerned about blood counts being low at the beginning, I will check more often, but otherwise I am just checking on the day of chemo on day one.

Andrew Schorr:

And what about a PET scan to see how things are working out?

Dr. Seymour:

I will usually get a PET scan after four cycles of therapy. Sometimes I will get it done earlier if there's concerns for progression or if I see if somebody who has a palpable node and it hasn't been responding, then I'll get a PET scan a bit sooner. But usually early means after two cycles. Typically I will check after four and then I will check at the end.

Andrew Schorr:

A patient goes through R-CHOP typically, they go through it over several months. Typically, how are people able to do? Can they work? Can they play with their kids or grandkids? What's life like for them during this time?

Dr. Seymour:

Again, it depends on who's getting it. If you're young, I have lots of young people who are still working. Maybe they take some time off to see how they do at the first cycle, but they actually are able to perform and function well. And a lot of these patients, particularly if they have higher stage disease are feeling much, much better after the first two cycles. Particularly if they're responding. Again, it kind of depends on the patient though. I definitely have older patients who are, they go through it and they can still tolerate it but perhaps they're just not feeling - like the fatigue is cumulative. They may be feeling a lot more fatigue toward the end of their course of therapy.

Andrew Schorr:

After the course of therapy though, do you find that people bounce back and feel better and hopefully at some point they see you and you use the C word for cure?

Dr. Seymour:

Yeah. Most of the time people will recover. Younger folks I feel recover much quicker than older patients. Older patients can recover. It depends if they were already a very athletic person to begin with, they recover a bit sooner. If they are not, they weren't very, if they were frail to begin with they may take a bit longer. I have seen some patients take a couple months up to a year afterwards if they were not tolerating of therapy.

Andrew Schorr:

Okay. Then you take a look at them, maybe you've had the scans, can't find the lymphoma, can people then hopefully go on with their life? And many people maybe they'll check in with you every year or so, but that's about it?

Dr. Seymour:

Yes, that's absolutely true. And we expect that for a lot of our diffuse large B-cell lymphoma patients. Often, right after they're done with therapy, I usually will follow all my patients every three months in clinic. No scans unless I'm following something with labs and a thorough physical exam. It's two years out, I spread that out to every six months and then when it's five years out, it's yearly. It definitely looks much different just even a few months out from therapy than it is when you are getting your first therapy.

Andrew Schorr:

Thank you for describing, taking us through really the diffuse large B-cell lymphoma for most patients today. And thank you for your dedication to these patients.

Dr. Seymour:

Thank you so much for having me.

Andrew Schorr:

Okay, Dr. Erlene Seymour from the Karmanos Cancer Institute. I'm Andrew Schorr with Patient Power. Remember, knowledge can be the best medicine of all.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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