Dr. Sharman -- Part 2

A few weeks ago, I posted a link to a blog by Dr. Jeff Sharman; I was very impressed with the entry, which focused on how he treats lower-risk Follicular Lymphoma. It was clearly written, provided lots of context and lots of links, and generally did a great job of explaining his approach.

I've finally caught up with part 2, where he discusses his approach to patients with higher risk fNHL.

I am not, officially, in the category of "higher risk," at least not according to the FLIPI scale (as Dr. Sharman explains in part 1), at least not now. But, as he also points out, there is always the risk of transformation to a more aggressive version of NHL, and so it's worth thinking about. (I take issue, though, with Dr. Sharman's understatement: "Occasionally follicular lymphoma takes on a bad attitude and "transforms" into Diffuse Large B Cell Lymphoma (DLBCL)." The "occasionally" seems a bit off, given that, depending on the study, transformation occurs between 15 and 50% of patients. Transformation is too big a fear in fNHL patients to brush it off with that sentence). In addition, more aggressive treatments are worth thinking about because eventually they may become needed, even if things stay relatively low risk. Rituxan stope working at some point.

I liked what Dr. Sharman had to say about the state of chemo for fNHL. Essentially, R-CVP is out. I know it still gets used -- I just saw a post from someone in the support group who is in the middle of treatment -- but it seems like Bendamustine has replaced it as the alternative to CHOP with fewer side effects. According to Dr. Sharman, it seems like Bendamustine is going to be the first choice now, with CHOP reserved for transformation. This sounds very much in line with what I've heard elsewhere.


So, overall, I liked this post a lot. Once again, a very clear summary of the state of the field. Dr. Sharman's specialty is CLL, another version of NHL, but I'll keep an eye on what else he has to say about Follicular.