Lymphoma In The Elderly

[viv41]

I have a very dear and close elderly relative who has recently been diagnosed with lymphoma. The whole thing has taken literally months from scans, X rays to a biopsy, diagnosis (last week) and now when she had to visit the hospital yesterday to, we thought, find out what treatment she needs, they took yet more blood samples from her and STILL no sign of any treatment, as she has to wait for the results of these blood tests! Why is it taking so long? It worries me that she is 84 and that is why they are not rushing things - hope I'm not right. She looks well, feels well and eats well, but surely she needs to start treatment ASAP ?? Sqad ??

[Sqad]

Peter pedant has personal experience if this disorder, but i will give you my appraisal of your question.

Lymphomas come in many shapes and sizes, each type responding to varying treatment regimes and it is important to pin-point the exact type.
This may take many blood tests, biopsies and and scans and all this takes time.
Yes.....I do think that the investigations have been slowly forthcoming.

Now, in the case of your friend, Lymphomas in the over 80's are quite a different kettle of fish from those in younger patients. The prognosis is worse and the side effects of treatment regimes are more severe and debilitating.

I do not know what type of Lymphoma your friend has, but my comments above apply to ALL lymphomas in patients over the age of 80.

Please realise that my comments simplify a complicated disease.

[Sqad]

P.S I am off to my Club now, but will be back in 2 hours for any questions.

[viv41]

She's a very dear relative Sqad. Forgive me Sqad, but what do you mean when you say the prognosis is worse ? Does the fact that she doesn't seem to be suffering in any way not help matters? She is hoping she can just take a pill instead of chemo infusion, do you think this is possible? Sorry if my questions are difficult to answer, but I am quite devastated actually. Thank you Sqad.

[viv41]

Will check back in later .....

[Sqad]

\\\Forgive me Sqad, but what do you mean when you say the prognosis is worse \\\

Prognosis means the outlook and I mean that the "outlook", survival rate is worse in the over 80's in spite of treatment.

The problem is with this age group is that they often have a concomitant disorder (some other medical problem), arthritis or heart problems ect and hence with chemotherapy and its side effects, taxes the spirit and endurance to it's limit, succumbing to infections, low white cell problems and heart and lung complications.

The two main types are Hodgkin's Lymphoma and Non-Hogkins Lymphoma and my comments above apply to either type in the over 80's group.

She will be offered chemotherapy and or radiotherapy but it is unlikely, very unlikely that she will be offered just "popping a tablet."

I am sorry to be downbeat but i would not like to implant unrealistic expectations for your friend, in your mind.

[viv41]

Thank you Sqad, I know you have to be truthful even if it hurts. She does have arrhythmia. The pill she has heard about is a 'chemo pill', no idea if there is such a thing. We'll just be there for her and keep her positive, but she is quite positive anyway, thank God.

Thanks again x

[237SJ]

Some chemo drugs can be given orally - they tend to give them to elderly patients as the effects are not a gruelling as intravenous treatment. Maybe that is what your relative has heard about.

[viv41]

Thank you 237, but she is adamant that it is a pill. I just have to trust that they give her the best 'type' for her age and health.

[slaney]

Not all lymphomas need treatment ASAP. There are many different kinds, and some of the low-grade lymphomas need observation in the first instance, and treatment with simple oral chemotherapy if necessary.
It is possible to treat a 84 year old with high grade lymphoma although the risks/benefits of treatment have to be carefully considered.

[viv41]

Thank you slaney, it HAS taken a long time and was worrying me, but coming on here has made me understand more.

[237SJ]

viv41 yes, orally is a pill.

[viv41]

Oh I'm sorry 237, I had it in my head that you meant a liquid when you said orally - duh !!!

[Peter Pedant]

Hi Slaney ! nice to see you posting !
Just off to see Circque solaire in Lundy with the Acci left overs
so I cant be that bad....
Hi sqad !

Viv this sounds par for the course to be honest
I think if you count it up you will be inside the govt guideline of 60 d

and Slaney is right - lymphoma comes in many different flavours.... so

she vivz fren' needs a bipsy and will have had a general diagnosis
Now the same samples are sent to the reference lab

and they send back goobledegood [ BCL2+ CD20+ blah blah blah )
after about seven or fourteen days. They really do have a hooiie and flick up slides in a dark room and people vote like in the voice......

then she needs a scan but that has probably been done TBH

The tmt as slaney says depends on the gobbledegook above

fr'instance if she has my disease NHL lymphoma showing CD20
then they may well give RCHOP - - in younger people this will give you 5 years in three quarters of the people having the goop

but hey 84 y o may not live five years !
so there is a different way of explaining it (SMR)
recollect that 85 y o do die from other things

If she has a " low grade" lymphoma as one of my colleagues did in the same department ( blimey we dont sound a very health lot do we ? ) they may do nothing until there are symptoms

Remember that you are a third party and she may not be telling you everything for reasons like she cant remember it all .....

Hi slaney ! I regret to say I have relapsed and salvage therapy is not going that well -one and a half cycles achieved in seven months. Blood count currently flat - but hey I seem to have got over 'flu without neuts and lymphos so who needs white cells I say !

[slaney]

Just to add if she looks and feels well this is very much in her favour, as it suggests an early stage.

Hi PP - very sorry to hear that. What salvage treatment are you having?

[viv41]

Thank you slaney, she does look and feel well, thank goodness.

Peter - sorry to hear you have it x I think her tests are final now, she has had everything and been diagnosed, so we're hoping these latest blood tests will tell us what treatment she needs.

[viv41]

Thank you all for your help x

[slaney]

You're welcome.
In my experience some 80 year olds can do well on treatment-I hope the same is true for your relative.

[viv41]

slaney - are you in the medical profession or do you know people who have had it ?

[slaney]

I'm a retired consultant haematologist, so this was my area of expertise.

[viv41]

Oh that is so good to know because I have been heartened by your responses. It is the haematologist she saw on her last visit (yesterday). Will this be the visit that determines her treatment do you think slaney?