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Pruritus returned after completing NHL chemotherapy
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Pruritus returned after completing NHL chemotherapy

Year ago I was diagnosed with NHL. Symptoms: enlarged groin lymph glands, severe pruritus (generalized, scalp worse), tinnitus, flu symptoms AM, and night sweats. Biopsy confirmed the diagnosis. I underwent a course of six chemo treatments (vincritine, drug X, prednisone) over 18 weeks. After the first treatment, all symptoms remitted, except the lymph gland enlargement, which cleared more progressively until gone. Two weeks after completing the last treatment, the pruritus and other symptoms resumed, but were less severe, and without the night sweats. I was started back on prednisone, 20 mgs daily plus clobetasol foam (another steroid) intermittently. That was six months ago. The oncologist was skeptical of active NHL return and referred me to two dermatologists, but neither of them did any diagnostics to find out the underlying cause. Pruritus and other symptoms continue at the same level today.

Does this circumstance sound familiar to any one. Thanks.
Tags: NHL, pruritus
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Avatar_n_tn
Hi.
Did you have work-ups done after completion of treatment to check for complete response to treatment, and several months after treatment to check for recurrence ?
What is your latest LDH level?  An elevated level could mean a relapse or recurrence.
NHL can recur or relapse after treatment.
I suggest you go back to your oncologist for proper evaluation.  
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Avatar_f_tn
Dennis is right, and you may wish to talk to your doctor about a course of Rituxin as well. It has been found to be VERY helpful in keeping  b-cells in check,, even increasing its cleaning talents over time for some patients. Its a biological agent, so while a large dose of benadryl must be given at the start of the treatment, the side effects are very minimal. The only thing I ever noticed was 2 days after treatment I sometimes feel a bit like Iv got the flu,, but within 48 hours I feel good as new.

*Best wishes and I hope you find the answers your seeking*
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Avatar_n_tn
First let me thank you for responding and the information you are providing.

As I mentioned, the symptoms recurred only two weeks after the last treatment. The oncologist, who I have a great deal of respect for as being science minded, did send me for a CT scan afterwards. The radiologist reported full remission: no lymphadenopathy (if I am spelling that correctedly). The groin lymph glands appear normal or normal size. That indicated to him that I was responsive to the therapy. I should also note that all my symptoms, except the lymph glands which took longer, disappeared after the first week of treatment.

I did not mention it because this post would have been too long, but the oncologist ordered another CT scan and a liver/spleen scan to be completed next week. He is also concerned that I use alcohol in the morning and evening to dull the itch (yes, I know that it can also exacerbate it and not a great idea). But it takes 3-4 hours before prednisone kicks in, then its effects only last 7-8 hours. While it does not remove the itch, it makes it tolerable.

I will discuss Rituxin with him when I see him in two weeks. Thanks for the suggestion.

I could go on about this condition but I'm afraid it might complicate matters. But three and a half years ago I experienced (along with my wife) an acute invasive mold infection from a moldy rug we were removing from our house. The same symptoms I have now (plus the night sweats) appeared. That's when I first saw one of the dermatologists. I was treated with depot prednisone, then prednisone plus OLUX,  then I got a referral to an allergist. He did complete skin testing, and between the skin tests and blood tests performed, I was totally negative. The molds tested however were only four, those which tend to cause potential internal organ infection, even meningitis, like aspirgillus and stachy batrus. He would not go on with the investigation even though there were blood tests for another 15 or so molds available. I continued on prednisone and OLUX, but with effort, I titrated the drugs down and was off in about a year and a half.  Although I did not feel as good as I used to, I did not use prednisone again until the onset of the lymphoma a year ago. Interestingly, when I saw the first dermatologist  recently, he remembered me and his referral to the allergist. On a lark perhaps, he tried me on two antifungal agents: Diflucan (works on Candida), and voriconazole (Candida plus other mold infections like fusarium in roughly half the patients tested). Three week trials of each were ineffective.

I am unable to find any literature on a relationship between mold infections and cancer, in spite of the similarity of the symptoms.

Thanks again.
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Avatar_n_tn
PS: I don't know what my LDH level was if one had been done. While it doesn't answer the question, according to the oncologist, my blood tests were WNL. After the six chemo treatments, however, my RBC count became borderline, at the cutoff, in fact, whereas my WBC count was a bit above that.
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Avatar_f_tn
you know I dont want to leave you hanging, and Im not a profesional so all I can do is relate to your experince and try to offer support... but I actually read your post earlier and decided not to answer as something you said sends of a bit of a bell in my head. I a have also read that fungal infections, particularly those that infect via the lungs, can cause lesions in the body that mimic as you said NHL.

This caught my attention because we had black spot fungus growing seasonally on the drywall of our prior home (where we lived when I was diagnosed), so naturally this sent off alarm bells again in my head. The first time I read that elsewhere I tried to dismiss it,, but it does seem strange since I also had a doctor recently tell me he suspected I might have caught, years ago, Valley Fever while in southern califofnia due to the symptoms I had and mentioned. I have since left that house, but we still own it and now Im concerned about selling it. I certainly dont want anyonelse to go through what I have if indeed there is a connection.

So am I understanding you right, that your wondering what the chances are that the fungal spores may be triggering the lymphatic response... or am I in left field with this?

What kind of health insurance do you have if I may ask? Is it an HMO, PPO or other? Considering some of the terrible stories we have all read in the last few years about non-medical insurance investors making medical decisions for their clients, I would wonder if this doesnt have something to do with the practice your going to now not mentioning the Rituxin as part of your treatment plan.

If you come out of remission for certain , what is your doctor suggesting as a next step? I would assume a stem cell transplant,, Rituxin is quickly being used nationally atleast and seems to for now be considered top of the line , at times doctors are even using JUST rituxin in very early stage cases and managing to achive remission with JUST this minus the life sucking chemotherpay. Its definatly something Id want my doctor to consider before chemo again.

*Sincerely wishing you comfort* Jennifer
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Avatar_n_tn
Hi.
To answer your question regarding a link between molds and cancer, there are molds that can cause cancer, specifically hepatocellular carcinoma.
It would be best to check first if you have indeed a recurrence of lymphoma.  If there is a recurrence, you can be given second-line chemotherapy.
Studies show that Rituximab improves the overall response rate as well as survival in patients with lymphoma.
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Avatar_n_tn
Thanks once again for responding and sharing information. I will discuss Rituximab with my oncologist at my next appointment.  I have PPO so that coverage should not be a problem. Sorry about your own ordeal with mold, Jennifer. My curiosity is related to the almost identical symptoms in both experiences. However, I did not notice enlarged lymph glands with the mold infection, although I did not specifically look for them.
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Avatar_n_tn
I can finally get back to answer some questions above.

My LDH level was WNL. The oncologist ordered another CT scan and a nuclear liver/spleen scan to attempt to explain the recurrence of lymphoma onset symptoms (pruritus, tinnitus, flu/cold symptoms AM, generalized ill feelings). I have been on 20 mgs prednisone plus OLUX (clobetisol foam) externally, but in the meantime, I had restarted Zocor, a statin, obtained from my GP. I had been drinking rum in the morning and evening before and after the 7-8 hr period of prednisone relief for 7 months at the time of the scan.

The CT was normal (no lyphadenopathy), but the nuclear liver scan show mild colloidal shift indicative of hepatocellular disease. No other abnormality. The oncologist immediately attributed it to the drinking, and of course stopped it cold. I have to check with him in one month to see if any remission occurs. About this, I am skeptical, because the symptoms resumed only two weeks after the last chemo treatment, and during that treatment all I drank was sweet wine, sometimes up to a bottle a day, usually to get over the tiredness and lethargy resulting from the chemotherapy, so I could do things in the yard and around the house.

Thanks again for your responsiveness.
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