My Chemotherapy Medications:

Chemotherapy Round 1-4 EPOCHR

Cyclophosphamide (Cytoxan, Neosar)

Doxorubicin (Adriamycin, Rublex)

 ♥Vincristine (Oncovin, Vincaster Pfs)

 ♥ Rituxan (Truxima)

Rasburicase (Elitek)

Etoposide (Toposaur, Vepesid, Etopophos)

Chemotherapy Round #5 RCHOP

♥ Cyclophosphamide

♥ Doxorubicin

♥ Vincristine

♥ Prednisone

Chemotherapy Round #6. HYPER-CVAD

♥ Cytoxan

♥ Adriamycin

♥ Oncovin

♥ Decadron

♥ Mesna

♥ Methotrexate

♥ Leucovorin

♥ Cytarabine

Possible Side Effects:

Inflammation around the port, hair loss, diarrhea, poor appetite, fertility loss, low blood pressure, itching, blue lips, nails and skin, burning sensations, nausea, vomiting, light headiness, chills, fevers, stomach pain, trouble breathing, low blood count, weak immunity, forgetfulness, nephropathy, urine may change color, eyes watering, extreme fatigue, bone pain, numbness, extreme shakiness, tremors, etc

Primary Mediastinal B-cell Lymphoma

Primary mediastinal B-cell lymphoma (PMBL) is a cancer of mature B-lymphocytes. It is a form of non-Hodgkin lymphoma, which is a type of cancer that originates in cells of the immune system, called lymphocytes

  • Primary mediastinal B-cell lymphoma is a rare type of non-Hodgkin lymphoma and is most common in adolescents and young adults.
  • PMBL usually starts in the area of the thymus, in a part of the upper chest called the mediastinum.
  • Under the microscope, PMBL looks similar to both diffuse large B-cell lymphoma and to Hodgkin lymphoma.
  • Primary mediastinal B-cell lymphoma often presents with symptoms of cough, shortness of breath, or swelling of the head and neck, due to the tumor pressing on the windpipe and the large veins above the heart.
  • With current therapies, many children with primary mediastinal B-cell lymphoma are cured of the disease.

Patients present with an anterior, often bulky mediastinal mass, and may have associated respiratory symptoms. Superior vena cava (SVC) syndrome can occur with facial swelling, dyspnea, headache, neck vein distention, and occasionally, thrombosis. Patients typically have bulky, stage I or II disease and B symptoms (fever, night sweats, weight loss) at diagnosis. Intrathoracic extension into the lung, chest wall, pericardial and pleural spaces is common, however, extrathoracic disease, including bone marrow involvement, at presentation is rare. Further spread to peripheral lymph nodes is infrequent, although localized extension to the supraclavicular nodes can occur. Unusual extranodal sites can be involved at relapse such as the liver, kidneys, and central nervous system.

PMBCL tumors have a diffuse growth pattern of large cells with clear cytoplasm and it is commonly associated with fibrosis, which tends to compartmentalize the tumor.

The following immunophenotypic markers are characteristically positive: CD45 (leukocyte common antigen) and the B-cell markers CD19, CD20, CD22 and PAX5. However, unlike other B-cell lymphomas, they can lack surface or cytoplasmic immunoglobulin (Ig), despite expression of the Ig co-receptor, CD79a. CD30 is often present, but is usually weak and heterogeneous, in comparison to classical Hodgkin lymphoma (CHL). However, CD15 is absent.

Most cases are CD10 negative, but have multiple myeloma-1/interferon regulatory factor-4 (MUM1/IRF4) positive phenotype with variable B-cell lymphoma 6 (BCL6) expression. Tumour cells are CD21-negative, but can be CD23-positive in up to 80% of cases, consistent with possible thymic B-cell derivation. Expression of MAL antigen, a lipid raft component, is another unique characteristic feature of PMBCL, not found in other DLBCL. Lack of HLA class I and/or class II molecules has been reported.

Thus, the diagnosis should be based on the typical clinical presentation, in addition to the distinctive clinico-pathologic features.

What should you tell the patient and the family about prognosis?

Overall the cure rate of PMBCL is excellent, and in the MINT and Greek retrospective study, approximately 80% of patients are cured with front-line R-CHOP chemotherapy. These results are also consistent with results from another study, evaluating the outcome of patients treated with R-VACOPB (rituximab/etoposide/ leucovorin/doxorubicin/cyclophosphamide/vincristine/prednisone/bleomycin) or R-CHOP, where the 5 year progression-free survival (PFS) was 81%. Further, in contrast to DLBCL, late relapses are uncommon, with a plateau in the survival curve beyond 2 years. Rarely, central nervous system relapses, typically parenchymal, can occur and it is unknown if the routine use of rituximab has reduced this risk.

The International Prognostic Index (IPI) which incorporates age (greater than 60), elevated LDH, advanced stage (III or IV), performance status (greater than two) and number of extranodal sites, was originally developed in diffuse large cell lymphoma, prior to the recognition of PMBCL. Thus, although there may have been cases of PMBCL included in this analysis, they were not evaluated as a separate group. Subsequent studies evaluating the IPI or the aaIPI (age-adjusted) have been discrepant in PMBCL. This may in part, reflect differences between studies assigning patient as stage IV or stage 2E if multiple but contiguous extranodal sites are involved.

In the few studies that have found the index useful, it has been the IPI that was applied, suggesting that it is primarily age that drives the poor prognosis. Even if the age-adjusted IPI is used, which eliminates the number of extranodal sites as a risk factor, most patients will have an elevated LDH, again reducing its discriminatory power. Other factors in individual studies that have been found to have a prognostic relevance include pleural and/or pericardial effusion, and poor performance status.


Primary Mediastinal Large B-Cell Lymphoma Cancer

Here is a more in depth article about my cancer ♥

Primary Mediastinal Large B-cell Lymphoma Cancer then stage 2b is my diagnosis.

The treatment is called EPOCHR. That’s what the medications listed next go into.

“Don’t give up”

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