R-Chop Vs DA Epoch for PMBCL

I am in the States. Radiation is rarely used (here)

in lymphoma due to it being so susceptible to systemic therapy such as chemotherapy and targeted therapy. There are "general" short and long-term effects of all therapy, but not all experience them and not all to the same degree. Age, genetics and general health all affect the outcome. What is worse is that little can be predicted or known ahead of time. I was given high-dose CHOEP-14 in 2008 for stage IV T-Cell Lymphoma, and while it was certainly survivable, I cannot say that it was pleasant toward the end. Subsequently I received 15 other drugs at maximum doses for a relapse, as well as a second T-Cell Lymphoma and Myelodysplastic syndrome in my marrow. Total body irradiation followed in preparation for a stem cell transplant. 

   As to R-CHOP, the Rituxan is generally well tolerated. The CHOP itself has known toxicities, mostly long-term cardiac issues from Doxorubicin and peripheral neuropathy from the Oncovin. Neuropathy tends to moderate with the passage of time. Somehow, I avoided the cardiac issues but not the neuropathy. The decision depends on many factors including the peculiar makeup of your PMBCL. It may have a genetic component which makes it more susceptible to one treatment or the other. I would say that, in general, R-CHOP "may" be less toxic and provide perhaps a quicker response. DA-EPOCH is also well tested and effective, although a bit more of a compromise.

Sadly, we have no way of knowing beforehand which is best. Often, choosing one regimen eliminates the other. And  what can be worse is that when all is said and done, we never really know if what we chose was best for us. It must be a leap of faith at some point. The "unknowns" are huge and lead to much consternation and anxiety. At some point, after consultation with doctor and personal research, we make a decision and stick with it, remembering that we are literally fighting for our life and that there is no way through this war without some injury.

All in all, I survived the lot of it and am delighted to be anywhere at all.  

Hi Survivor24 and a welcome from me to the group.

Some people do at times require some targeted  radiotherapy if there is any left over hot spots.

I can’t comment about R-CHOP…… but I had 6 cycles of R-EPOCH but not (DA…… Dose Adjusted)….

My R-EPOCH was specifically used to open the door for me to go onto have a Allo (donor) Stem Cell Transplant (SCT)…….  Without a SCT my remission was going to be very short.

My story is rather complicated (See my story) I was first diagnosed way back in 1999 at 44 years old with a rare type of Low-Grade T-Cell NHL…….. I then had to go onto have significant treatments mainly due to me developing a second more aggressive type of High-Grade T-Cell NHL in late 2013……….. You will see from my story that I do have some post treatment left over health issues…… but I am 9 years out from my last treatment and turn 69 in a few weeks and I am doing great.

I suspect that the reason for less reliance on radiotherapy in the States is due to the civil liability environment.

Interesting to know that radiation is out of the question. 

And you are so right, you will just never know the two sides of the coin. 

I am from dubai, and since there are no real law suits or medical institutions being sued. You need to do a lot of groundwork yourself to make sure you are getting the tailored treatment as per your diagnosis and not being pushed something which is just available at that particular hospital.

You are doing some really great work of giving back to humanity. One is so lost when the news hits you and I believe things start settling once you get into the drill of it.

So i am assuming DA EPOCH is an advanced version of R EPOCH and it did not exist at the time of your treatment?

You might even inquire of some of the major cancer institutes in Europe, American or possibly Japan as to their experience and recommendation, as different doctors and different hospitals have preferred methods of treatment.

It’s the other way round as the addition of the R = Rituximab makes this a more effective wide ranging treatment…… the specification of treatments is all about what is needed to do the job….  (DA) Dose Adjusted simply means they may play around with the treatment based on its progress…… there was no playing around with my R-EPOCH as it was being used for a specific purpose to open that door to SCT.

can you pls name few of these institutes in europe and america .

got it 

Certainly.

In England, there is the Christie National Foundation trust:

https://www.christie.nhs.uk/

In Japan there is the National Cancer Center:

https://www.ncc.go.jp/en/index.html

In Heidelberg, Germany there is the: https://www.heidelberg-university-hospital.com/diseases-treatments/cancer-and-tumor-diseases/hematology-oncology-and-rheumatology

In the USA there is: Memorial Sloan Kettering

https://www.mskcc.org/

Dana Farber Cancer Research Center

https://www.dana-farber.org/cancer-care/types?rows=20

Fred Hutchinson Cancer Research Center:

https://www.fredhutch.org/en.html

MD Anderson Cancer Research Center:

https://www.mdanderson.org/

And also MD Anderson in Spain:

https://mdanderson.es