Diffuse large B-cell lymphoma (DLBCL): R-CHOP-14 or 21

@sbergerkinkade
I am at a point where I have to start treatment or say no. I have lung issues already, I have had 2 strokes in the past. 1 in February when they found my Aggressive Large B Cell Lymphoma. Pet scan showed it only in my spleen, which was removed. I was then asked to undergo a Cardiology screening and a Pulmonary screening while my broken foot healed before any Chemotherapy.
Could I ask if the r-chp caused any lasting effects for you and if so what and for how long?
At 64 with my previously mentioned health issues quality is more important to me than quantity at this point.

Diagnosis confirmed by biopsy: widespread DLBC L in pelvic area and breast. Currently undergoing Bite therapy . No surgery although the breast mass seems to be well defined. History: CNS lymphoma treated with R-MVP ; 8 cycles plus consolidation following with Cytarabine; 5 years NED.
Bite therapy is approved for patients with prior chemotherapy , age plays a role.
PET Scan scheduled next week to check response.

Hi @kat7707 While you're waiting for a reply from @sbergerkinkade and other members with DLBCL to reply, I want to welcome you to Mayo Connect. You're in a tough position of having to make a decision which may impact your life ahead. I can understand, with your previous health issues of stroke and a lung condition, that you're not eager to rush in to a chemo regimen.

RChop consists of five drugs, which when used in combination have shown to be quite effective in treating large B cell lymphoma. As with any chemotherapy treatments, quite honestly, there can be side effects such as nausea, hair loss, possibly neuropathy, etc. However most often the side effects disappear after treatment and recovery. If all goes as planned, enduring those early months of therapy may add many more years of a healthy life for you. I was 65 at the time of my treatment for another type of aggressive blood cancer. It wasn't easy but so far I've bought myself another 7 years of a great life that would have been over had I not taken the chance.

But I know you'd like some answers before you take on that challenge, right? Since you've had two strokes previously, has the impact of these past events been discussed with your oncologist and other doctors who treated your strokes?
Before you proceed with the treatment it would be good to have a consult with your doctors about any potential complications because of your strokes or lung issues. You may also inquire frankly, if you choose to do nothing, what does that scenario look like. It's perfectly acceptable to inquire as to risk vs reward.
But at 64, you're still very young...too young to not look into the future.

Was there an underlying which caused your strokes? If you don't mind sharing, what lung issues are you having?

Hi @kippi1950 If I remember correctly, this diagnosis of DLBCL is for your wife? I'm sure you're both on pins and needles waiting for this next PET scan next week. When we're in treatment for cancer, we pretty much live from one scan to the next. Wishing only good news for her (and you!). Will you let me know what you find out from the scan? Sending a hug.

@loribmt
Hypertension is the only known factor for the strokes.
The lung issues are classified COPD but the actual problem is that I take in the oxygen it just doesn't diffuse as it should to the vital organs.
My concern is the brain fog and fatigue that some say lingers after chemo. I have been blessed to get a return of my facilities from the stroke as well as most of my physical abilities. The physical is slower and not as steady and my hands shake a bit now. I don't want to loose that or become dependent on others.

@kat7707 It’s certainly understandable to have concerns about brain fog and fatigue which can be associated with your treatment for aggressive B-Cell lymphoma. Especially after your awesome recovery from 2 strokes! That’s no easy feat and you don’t want to feel as though you’ve relapsed from stroke recovery with brain fog again.

From my own experience, I did have fogginess from the chemo for AML and the bone marrow transplant. Caught me by surprise because I’d never heard of it before. So when I struggled finding words I was a bit panicky. Then a friend of my daughter asked me if I’d been having any brain fog. That his mom had it during her cancer journey! Wow, I felt a huge sense of relief at least knowing the cause. The good news was the fog gradually dissipated over the months during recovery. It was never debilitating just a little frustrating. I kept up with memory games, crossword puzzles, sudoku, that type of thing which seemed to help.

Fatigue…whether you have treatment or not, I suspect fatigue will accompany your lymphoma as it progresses. Cancer cells take a lot of our energy along with our bodies trying to fight it. Huge calorie burn. That’s one of the reasons why people lose weight with a cancer diagnosis.
Again from my own experince, once I was beyond treatment, fatigue was replaced by energy and stamina from no longer fighting the cancer. I’m 72 now and very active. I hope this would be the same for you once your lymphoma is in remission. That would be the goal, to return to a relatively normal life.

My concern is, if you don’t have treatment, what is the risk of progression of your disease and how quickly. Would you be willing to trade a few months of fog and fatigue for the possibility of extending your life? Or are you willing to take your chances with the lymphoma without treatment but it may be a shorter time for you? That’s a lot to take in…and a good discussion to have with your healthcare team.
Do you have family or friends with whom you can weigh your options?

Thank you for response. I have talked with family most are as divided as I am.
I need to explain I am not suicidal but I am firm in my belief in the Lord.
I have buried two husbands and the fact that I was caregiver for my second husband who passed 11 months 4 days ago from a blood cancer called myelodysplastic syndrome, adding a new level of concern as his second full chemo treatment lowered his white cell count to the point of sepsis and death from organ failure within 36 hours of his fever on day 7 of his treatment schedule. (21 day)
All of this to say I want real experience not Dr. s word for it.

Hi @kat7707 I absolutely understand where you’re coming from on your thought pattern going forward. Having the loss of your husband so fresh in your mind, this is an awful lot for you to take in. I am so very sorry to hear of your husband’s passing from MDS. While every attempt to treat or cure the disease is made, there is never any guarantees for the outcome. Chemo is very good at wiping out rapidly dividing cancer cells. Unfortunately it can’t discriminate between other rapidly dividing cells, which include blood cells. So the blood counts naturally fall along with the treatment. That left your husband very vulnerable to neutropenia with an infection developing.
So of course you’re very concerned that with pending chemo treatments of your own this could be a similar story for you.

I’m a mentor in this Blood cancer group and also for Bone marrow transplantation, having gone through my own aggressive leukemia journey. While I had great medical teams working with me, I also learned how valuable it is to be able to speak with someone who has walked the walk. There are 800+ discussions in Connect related to Rchop Chemo treatments for lymphoma (and other cancers). I’m posting the results of the search for you. This way you can look through the list to read what’s of interest to you.
Please feel free to tag any member you want to speak with by clicking the blue reply box under their reply. Or type their @name in your reply. That way they’ll get a notification and can respond to you.
Rchop Chemo results:
https://connect.mayoclinic.org/discussion/r-chop-chemo/
Here is one of the discussions you may want to read through:

Anyone had long term remission R-CHOP chemo for Large B-Cell Lymphoma? https://connect.mayoclinic.org/discussion/r-chop-chemo/

Hopefully you’ll be able to get a little more feedback of what to experience in helping to guide you with your decision. If you need a sounding board I’m here for you any time. Will you please let me know what you decide?

@loribmt
Thank you, I will check out the link.
I feel like the past 2 years have been very close to the Too Much line.

We are currently with Memorial Sloan Kettering and Yale. Both use bispecific antibody treatments in cases where R-CHOP is regarded as deleterious.
Not without side effects but you are treated as outpatient, an indication of manageable side effects. An example: an auto injection of white blood count stimulation at home.