Re: Help with insurance - Richters or a parallel disease?.

[Guest guest]

Marilyn,

The most important part of this is establishing the

diagnosis of the bright node as a diffuse large B cell

lymphoma. Whether it is a parallel or the result of

transformation arguably should have no impact upon the

treatment plan. Most physicians would use R-CHOP, while

some might use OFAR. One important determining factor in my

opinion is the status of the CLL elsewhere and the amount of

prior therapy.

An important predictor of responsiveness would be staining

for p53 on the tissue sample obtained. While CLL is one of

the unique situations where we see loss of p53 function due

to a deletion (and therefore do not see it on staining), in

large cell lymphoma it is most commonly mutated, and is

therefore seen on staining. An FNA might just not have

yielded sufficient tissue to do all of the necessary testing.

Rick Furman, MD

Marilyn Barbera wrote:

/message/15895