Monday, March 9, 2015

Case Study: Transformed Follicular Lymphoma

Lymphoma Hub, a site aimed at health care professionals, posted a nice case study a week ago describing a the process for deciding on how to treat a patient with transformed Follicular Lymphoma.  The patient described is a 59 year old male, and the oncologist discussing the case is Dr. Nathan Fowler from M. D. Anderson Cancer Center in Texas.

The post, which includes both a video and a transcript, takes us through the whole process. First we see a brief history of the patient, who had an indolent, slow-growing form of Follicular Lymphoma, with no symptoms. Dr. Fowler favors watching and waiting for patients like this, since there is no Overall Survival benefit to treating early (as he points out).

In a follow-up a few months later, the patient complained of abdominal pain. We get to see his biopsy and PET scan results, and based on them, Dr. Fowler concluded he had transformed.

From here, Dr. Fowler goes through the options available. He is careful to point out that there are no  studies that compare treatments for transformed FL, so most of what we know is retrospective, looking back at patients after to see how things worked out. Not ideal, since researchers can't control who is in the studies, so there might not be an accurate comparison. But, it's all we have.

Among the options he discusses are Autologous Stem Cell Transplants, where a patient's own stem cells are removed and then put back in, and Allogeneic Stem Cell Transplants, where a donor's cells are put in. There's more to these transplants, and each has strengths and weaknesses -- enough weaknesses that neither can really be said to be a better choice than the other. If you want to read more on Stem Cell Transplants of both kinds, has lots of good description and links.)

Dr. Fowler also discusses chemotherapy options like R-CHOP, which he would recommend if the patient has not had CHOP or a similar anthracycline treatment before (since too much can cause heart damage).

Overall, it's an interesting look at how an oncologist makes decisions. I don't think any of us like to think about the possibility of transforming, but I like to know my options if it ever comes to that. This video/transcript is a good way to remind us of those options.


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