u/AdventurousGain345

Hi there,

I’ve finished DA-EPOCH-R 2 months ago and had my EoT scan a week and a half ago.

My team is opting for radiation (and biopsy) of this lymph node as SUV is higher than after two rounds of DA-EPOCH-R (interim PET). What is your opinion on this? I’m a bit worried to be overtreated when this might not be necessary.

Thanks!

Report
Lymph nodes
Above the diaphragm:
Compared to previous examination, FDG uptake in the lymph node in the anterior mediastinum has clearly increased. Whereas previously the uptake was located at the periphery of a possibly necrotic lymph node, the FDG uptake is now diffuse throughout the entire lymph node (15 × 22 mm, previously approximately 23 × 25 mm, Series 5, Image 212), unchanged DS4.
The previously increased FDG uptake in a lymph node right supraclavicular has clearly decreased, DS3.
Further no evidence of enlarged or FDG-avid lymph nodes above the diaphragm.

Below the diaphragm:
No evidence of enlarged or FDG-avid lymph nodes below the diaphragm.

Liver
The liver is unchanged, not enlarged and shows no increased FDG uptake (craniocaudal length 17 cm, previously 16.7 cm).

Spleen
Compared to previous examination, increased FDG uptake in the spleen has normalized. The spleen is not enlarged (craniocaudal length 11.5 cm, previously 12.7 cm).

Bone marrow
Compared to previous examination, the diffusely increased FDG uptake in the bone marrow has clearly decreased and is now clearly lower than the FDG uptake in the liver.
The previously strongly increased FDG uptake at the site of the fracture in the sternum has now clearly decreased, however not yet completely normalized, possibly a mixed pattern of healing fracture and lymphoma localisation (DS3).

Extranodal lymphoma locations
No evidence of extranodal lymphoma localisation.

Hey everyone,

So I just had my EoT scan after 6 rounds of DA-EPOCH-R for PMBCL (going up every round until the last two where I remained on level 5) and unfortunately it’s DS4 and my team is unsure if it’s residual disease or inflammation.

My interim scan (after two rounds) showed 3 spots at ds4 and my EoT only one very small spot but it’s a bit more avid than it was after two rounds. It didn’t grow or anything and also no new lesions (my mass wasn’t very big to begin with, never got told the exact size). They now want to biopsy the spot and radiate it, irrespective of the biopsy results as there’s a chance the biopsy fails because the spot is so small.

My oncologist is very optimistic and thinks radiation will clear it (if it’s even disease), and expects me to be done. If it wouldn’t be enough there is CAR-T but we are not there yet she said.

Clinically my bloodwork looks good (I feel great) and recovering every time (hb is normal range, hasn’t been this way since last summer!)

Any of you who have experienced this (in particular interim to EoT slight SUV increase)? I originally thought DS4 is generally watch and wait. Am I being overtreated by jumping into radiation directly?

I know the DS4 outcomes are very favorable in PMBCL (especially with radiation), and DS4 are common, but I can’t help to feel sad. I don’t know my SUV, my doctor couldn’t tell me just that it is a bit brighter.

Thanks!