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1996, Jan
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Original diagnosis of non-Hodgkin’s Lymphoma, follicular, small cleaved cell type (low grade) most cell positive for L-26 (CD20) and negative for CD43 and CD45RO Consistent with a B-cell phenotype (Dr. Daniel A Filippa, Memorial Sloan Kettering) Bone marrow not involved. Medical advice: watchful waiting.
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1996, Nov –
1997, Nov
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Treatment: antineoplastons (trial): 36% reduction at first, then mixed results, finally lymphoma changed grade and fast progression prompted end of therapy and start of chemotherapy. Needle biopsy inconclusive about grade change.
Thyroid nodule identified: Determined to be Hurthle cell discovered with CT scan while undergoing therapy for lymphoma.
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1997, Dec-1998, Apr
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Treatment: CR following six rounds of CHOP therapy (Cyclophosphamide (Cytoxan), Vincristine (Oncovin), Doxorubicin (Adriamycin), Prednisone.).
Following CHOP, a gallium scan reported no sign of lymphoma.
Joint pain prompted a bone scan. Result was negative.
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1998, Sept
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Thyroid surgery – not NHL-related Right hemi-thyroidectomy performed by Dr. Fahey – NY Hospital Cornell. Surgery went well; nodule appeared to be self-contained.
Pathology report: Benign - follicular adenoma, surrounding thyroid tissue unremarkable.
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1999, Dec
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Relapse of low grade follicular lymphoma. Axilla nodes detected in mammogram. Subclavical and neck node biopsy confirmed diagnosis. (B) We decided to watch and wait.
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1999, Dec –
2000, Jan
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Treatment: Rituxan 8x – partial response, approximately 35% improvement in palpable nodes. No scans taken. Labs, such as LDH, improved.
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2000, June 22-July 10
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Treatment: Anti-cd22 (hLL-2) 4x (trial) – No bone marrow involvement detected prior to treatment. Stable disease.
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2001, Feb 5
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Lymph node resection for Idiotype vaccine. Large 8x12 axilla node. May have caused Lymphedema in left arm.
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2001, Mar 29
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Treatment: Started Rituxan 4X once weekly, completed April 20, 2001, with plan to add oral low dose chemotherapy if needed. Significant pleural effusion and additional progression prompts treatment.
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2001, April 12
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Thoracentesis to remove fluid from around one lung. Nearly 2 liters removed. Probably caused by enlarged lymph node pressure on thoracic duct.
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2001, April 14-
July 1
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Treatment: Daily low dose oral PEP-C (one week overlap with Rituxan). Switched to every other day on May 16. Ended this course July 1 with very good response--80 to 90% regression. PEP-C: Prednisone, Etoposide, Procarbazine, and Cytoxan
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2001, Aug 1
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Removed Hickman Catheter. Dr. F noticed dark irregular mole and recommended it be checked out.
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2001, Sep
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Pre-melanoma mole removed surgically by Dr. G. Margins okay.
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2002, Dec 1 -
Dec 31
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Treatment: Daily low dose oral PEP-C with very good response--80 to 90% regression. PEP-C: Prednisone, Etoposide, Procarbazine, and Cytoxan (Used fish oil and Whey protein).
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2002, April - Sep
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Treatment: Idiotype vaccine (Favrille) Id+KLH + GM-CSF 5 of 6 as of Aug 13 Stable so far
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| 2002, Nov |
Rituxan + CpG (Stable) - clinical trial. |
| 2003, Jan |
01-03 oral low dose PEP-C (PR-90%) |
| 2003, Mar |
Inteferon-alpha-2b - hoping to consolidate the good response to PEP-C and hold off progression for subsequent vaccine |
| 2003, July |
Favrille idiotype vaccine (Stable) |
| 2004, July |
oral low dose PEP-C 4 week + 2 week every other day
(~90% response) bone marrow neg (PCR)
Note: Longer time to next treatment
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| 2004, Nov |
stem cell harvesting - cytoxan, neupogen
Note: PCR negative in bone marrow and low tumor burden.
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| 2005, Jan |
Bexxar - goal of treatment to get a durable CR. Realistic because of low tumor burden, disease still sensitive to treatment, and no detected bone marrow involvement. Let's hope. |
| 2006, Mar |
CR unconfirmed by imaging holding beyond one year. |
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Other
Concerns/Goals
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· Control osteopenia from early chemotherapy-induced menopause and direct effects of chemotherapy.
· Taking Zoloft for anxiety | Need extended referral for Dr. L.
· Screen melanoma periodically.
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