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

I believe in large part it depends on how quickly you can bounce back from your treatment. I had it sometimes every two weeks and sometimes every three weeks and once or twice at four weeks. This was all due to white cell count. I don’t think going every two versus three weeks has a huge outcome difference otherwise they would change the protocol. They can have a huge impact on you as an individual and quality-of-life however. I think this is an area where you have to develop a level of trust with your doctor. I would express your concerns and desires and listen carefully to his/her response.

@fwpoole, I'd like to invite a few other members to share their, or their loved ones, experience with R-CHOP. @valerie912 and @ginpene05 both discussed going through R-CHOP and may be able to offer some additional insight on their experience with it along with @ckeys'. @fwpoole, if you are comfortable sharing, which regimen are you going to be started on, 14 or 21?

Yes, I’m very comfortable sharing.

I’ve started on 21. I’m now 4 days post first cycle and am tolerating it pretty well, so far. So I’m considering speeding up the process.

In June, I had a tumor removed from my large intestine which was NOT colon cancer, but DLBCL stage 2. Prior PET and CT showed no sign of metastasis. The NCCN "Guidlines" suggests RCHOP X3 followed by radiation. Since the tumor has been removed, my oncologist tells me radiation is not necessary. Glad for that. I have finished 3 cycles of RCHOP-21 this past week and am scheduled for follow up PET/CT scan next week. If the scans come back negative, per the guidelines, I consider the treatment done since I have no tumor and radiation is not necessary. But, my oncologist is urging me to have one more cycle of RCHOP. Isnt the removal of the tumor equal to, or better than radiation of the tumor? So, therefore, RCHOP x 3 + ISRT - ISRT = RCHOP x 3 cycles.

My Oncologist claims there are no clinical trials that 3 cycles is enough for stage 2. But there are trials for 3 cycles with radiation of tumor/nodes. My tumor was removed along with about a foot of intestine. Isn’t removal better than radiation?
@ckeys @ginpene05

@fwpoole Removal is not necessarily relevant, especially in stage 2. Lymphoma is a circulatory cancer and because of that it can spread, which is why treatment almost always involves chemo. Removal of a node is usually just for biopsy, although there is some research on removal being treatment in very early stage, or less aggressive forms. Removal cal also contribute to spread as you open up possibility of cells leaking. Radiation can help when the tumors are localized, but less so when they are multiple or all over. Being stage 2 sounds like your cancer was already circulating in the area, so radiation can provide some additional benefit even if you had everything removed. I’m sure your doctor can explain why he’s recommended a specific plan.

FYI, I had my initial lymphoma in one node and the base of my tongue (stage 2e). The node was removed for biopsy and I was given chemo plus radiation. My cancer returned in same area. I hope you have success with what your doc recommends!

I did rchop last fall ending in February this year. I tolerated it fairly well, had 5 days of Zarxio shots after each treatment. The mouth sores were the worst part. I did a total of 6 treatments. The second being a half dose of rutuxin.

How many treatments and did you need radiation?

FWpoole, my first go around, I did 3 RCHOP, ever 3 weeks, followed by 21 radiation treatments. I’ve read in Cure magazine that chewing on ice chips during your chemo can help prevent mouth sores. I did the post treatment with L lysine and glutamate powder and my mouth sores were fairly tolerable. Talk to your doctor about magic mouthwash, too if you develop sores.

I didn't have to do radiation for my cancer.