R-Chop failed with lymphoma, What's Next?

[ronsolo306]

My wife (81 but in great physical shape) was diagnosed with stage 3 follicular lymphoma and began R-Chop therapy in August 2021, finished December. Pet scan late December showed a return of several nodes that an earlier Pet scan (October) showed "almost resolved". The Doctor is concerned that her condition has become more aggressive and has performed a biopsy of her "hottest" node. We are waiting for the results. What should be the consideration for the next treatment since R-Chop did not work even for a little while. She is skeptical of trying Car-T because of her age and because she has to have failed 2 courses of treatment prior to being treated with Car-T. Just trying to be pro-active and know of some 2nd treatments that might be beneficial to both her disease and prolonging her life with consideration for her age.

[gardening-girl]

Ron, I am so sorry to hear that your wife relapsed so soon from the R-CHOP treatment. As you indicate future treatment choices will depend on whether her FL has experienced histological transformation. If it has not, the following article may be helpful. It has very up to date information on treatment options and potential outcomes.

Prospects in the management of patients with follicular lymphoma beyond first-line therapy Haematologica Vol. 107 No. 1, January, 2022

haematologica.org/article/v...

I see that you have posted the same question to the Non-Hodgkin Lymphoma HU group where hopefully you will get some useful feedback.

Hoping that you continue to do well with your V+O treatment.

[ronsolo306 in reply to gardening-girl]

Thank you so much for this information. I sincerely appreciate it.

The V+O treatment went great. I actually completed the treatments in October and feel great. What a marvelous treatment.

Thank you again and all the Best!

[Mystic75]

Thoughts and prayers for your wife and you, Ron.D.xo

[Jm954 Administrator]

Hi there,I'm sorry to hear you are both facing this agonising uncertainty.

What you describe is the usual scenario to make a diagnosis of Richter's transformation and everything will depend on the results of the biopsy of that hot node. Often it's necessary to remove a whole node as a sampling biopsy can be inconclusive.

IF it's Richter's then you're right that, in the UK, you need to have had two failed treatments before CAR-T can be considered but this is further complicated as your wife has already had R-CHOP as a treatment for her Follicular Lymphoma and it may be thought that this is not an appropriate treatment if she does have a Richter's Transformation.

There are alternative chemotherapy regimes but they are all pretty intense and, despite her fitness, your wife's age may be a disadvantage in coping with it. The usual approach would be what is called intensive 'salvage' chemotherapy and then a stem cell transplant.

IF her FL has transformed then it is worth asking her doctor about clinical trials which could offer a different therapeutic approach. I'm not aware of any but that doesn't mean that they aren't out there. The largest Richter's Trial is called STELLAR but I'm not sure your wife would be eligible as the main treatment is R-CHOP.

I'm sending my very best wishes and hopes that it's not Richters. Please let us know what happens

Jackie