Q: My wife aged 48 years, was diagnosed with Non Hodgkin's Lymphoma, Follicular Grade II four years back. She underwent 6 courses of CHOP with 21 days interval. On completion of the cycle, alternate day Interferon injection was given for 1 year and we finished the same two years back. She was going for quarterly medical check ups and some nodes were seen. But the biopsy was not malignant. Then again some months back some nodes were seen. The growth was too small to 2.5 cms size in 3 months, when we did biopsy last week on the iliac nodes. The results are positive and we are advised to start CHOP again. It is grade I this time. Even after Interferon injections, what could be the reason for relapse? Will it get cured with CHOP? Or do you recommend any other course?

A:The patient has a low grade lymphoma, which have an indolent behaviour. Treatment with CHOP followed by interferon was an attempt to cure it or keep it under control. However the disease has recurred and may require either only observation or further treatment. There are multiple treatment options available including treatment with recently available monoclonal antibodies or other forms of chemotherapy and that may be discussed with the treating doctor. Patient may be retreated with CHOP also, if the dose of adriamycin permits.