Follicular lymphoma stage 4 grade 1?

My brother is recently diagnosed as having follicular lymphoma stage 4 grade 1. He is having an abdominal mass as well. Our oncologist suggested to do R-CHOP but not urgently since it is slow-growing. We went for a second opinion anyway and now the decision is to take oral tablets of Chlorambucil (clokeran) along with steroid. Doctor told us to see whether he will respond to this medicines and if not, we can go for chemo...Have anyone taken this mild therapy first and responded?

Follicular lymphoma stage 4 grade 1?
Follicular lymphoma is generally considered incurable, but it associated with long life, especially the very low grade I types. They are typically stage IV at diagnosis so that is not unusual.





Multiple therapies are possible, all the way from watch and wait till symptoms to more aggressive therapies like R-CHOP. There is no one best answer here. You did not say how old your brother is, nor what is overall health is.





From my standpoint, for a healthy younger (%26lt;65) person I might favor R-CHOP. Response rates and rates of complete remission are MUCH higher than expected with chlorambucil/prednisone (CP). This does not always translate into a survival increase as the survival for this disease is so long anyway and one tends to get multiple successive therapies. (makes it hard to tell what effect any one therapy actually had). However, the odds that he will need to move to another chemotherapy anytime soon are markedly lower if he moves forward with R-CHOP rather than the CP regimen, as he is likely to get a better and longer-lasting response. The trade-off is higher potential for toxicity with R-CHOP, but it is generally well-tolerated. Another advantage for R-CHOP is it is less toxic to stem cells in the bone marrow (mainly since chlorambucil therapy is given for such a long time); this may or may not be important in this situation currently, but could impact future therapy decision-making.





God bless, best wishes
Reply:No, BUT my sister was diagnosed with the same exact disease. Last year she had a huge mass just above, behind her liver. She also had smaller masses throughout her neck down to pelvic area and in her bone marrow. We opted for the R Chop clinical trial, which used a combination of chemo and Radiation at the end. She did GREAT. One year later and they can find no masses and no trace in her bone marrow. I would reconsider chemo. The ONLY side effect she suffered was hair loss. She had a couple of bad days, and missed little to no work. She was amazing! I had heard such horror stories about side effects of chemo, but over a 5 month period was sick very little. I know how scary that diagnosis is. I was with her every minute, good luck and god bless you and your brother.