What to do if lymphoma relapses after chemotherapy

For any tumor, recurrence will be a sword hanging over the patient's head. All examinations and treatments after complete remission of blood tumor treatment are for one purpose, monitoring, prevention, diagnosis and treatment of recurrence. Doctors and patients are both worried about whether the tumor will recur after chemotherapy. However, if you keep worrying, it may lead to two consequences - excessive examination and treatment and a decline in the patient's quality of life.

How to determine relapse?

Patient: Female, 30 years old, diagnosed with NK/T stage IV group B, skin type three years ago, bone marrow biopsy showed lymphoma cell invasion, splenomegaly, low fever at the onset of the disease, 10 chemotherapy sessions, autologous transplantation on New Year's Day 2011. During this period, everything else was fine except that the white blood cell count has been around 2, and the platelets have recently returned to normal (the white blood cell count has been around 2 for three years since the onset of the disease). I recently had a PET-CT scan, which showed lymph nodes in the neck, the largest of which was about 1 cm, and lymphoma infiltration cannot be ruled out. I hope you can tell me what to do now? I don't know if it has relapsed.

Doctor: From the current situation, we can continue to observe whether this lymph node will grow. If you are worried, you can take another biopsy.

The patient's lymphoma was treated with 10 courses of chemotherapy and then autologous transplantation. In May 2011, the PET-CT of the neck lymph nodes was about 0.9 cm, and the maximum SUV value was about 3.1. In April this year, the PET-CT was repeated, and the maximum diameter of the neck lymph nodes was about 1 cm, and the maximum SUV value was about 3.1. Compared with the two, the changes were not too big, and the imaging changes and SUV values ​​of other parts did not change much. Considering that the patient has been about 15 months after the autologous transplantation, I think there is no obvious evidence of recurrence at present. Of course, the non-nasal type of NK/T lymphoma is more malignant, and it is necessary to strengthen monitoring and self-vigilance after treatment, but as long as regular examinations are performed, generally once every 3 months in the first 2 years after the end of treatment, and once every 3-6 months in the last 3 years, it is sufficient.

What if I relapse?

Patient: If the disease relapses, what is the best option if transplantation is not an option?

Doctor: If lymphoma (NKT) relapses after autologous transplantation, allogeneic hematopoietic stem cell transplantation should be considered, and chemotherapy should be performed first to control the disease. If transplantation is not considered, the only option is to switch to chemotherapy drugs that have not been used before.

At present, allogeneic transplantation is usually not used for consolidation therapy after lymphoma remission, because there are many treatment-related complications, and lymphoma usually does not involve the bone marrow. High-dose chemotherapy plus autologous transplantation can achieve better results, and it is very safe and has fewer complications. However, if the bone marrow is invaded by lymphoma cells, or lymphocytic leukemia, then allogeneic transplantation should still be considered. After relapse of autologous transplantation, the disease can be properly controlled through chemotherapy, and allogeneic transplantation can also be considered for salvage treatment.