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Isaac_Goldenberg
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Assessment
Primary Diagnosis:
Diffuse Large B-Cell Lymphoma (DLBCL) – Stage III. Diagnosis confirmed by excisional lymph node biopsy showing CD20+ B-cell lymphoma. PET/CT demonstrates multiple hypermetabolic lymphadenopathy in cervical, axillary, and retroperitoneal regions. Bone marrow biopsy is negative for involvement. LDH is elevated at 750 U/L. ECOG performance status is 1.
Secondary Diagnoses:
Mild anemia of chronic disease with Hb of 10.8 g/dL and MCV of 88 fL. Ferritin and iron panel suggest anemia of chronic inflammation.
Thrombocytopenia with platelet count of 120K, likely related to bone marrow suppression from lymphoma.
Hypertension is controlled on Lisinopril 10 mg daily.
Plan
Treatment for DLBCL: Initiate R-CHOP chemotherapy regimen including Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. Planned for six cycles with interim PET-CT after cycle three. Anti-emetics include Ondansetron as needed and Dexamethasone for nausea prevention. Neutropenia prophylaxis with Filgrastim if ANC drops below 1.0. Tumor lysis prophylaxis with Allopurinol 300 mg daily.
Surveillance and Monitoring: Repeat PET/CT scan after three cycles to assess response. CBC, CMP, and LDH will be monitored with each cycle. Baseline echocardiogram is required due to anthracycline use.
Supportive Care: Anemia will be monitored with Hb levels, with transfusion considered if Hb drops below 7.0. Thrombocytopenia will be monitored, and dose adjustments will be considered if platelets drop below 50K. Neutropenic precautions will be taken, and antibiotic prophylaxis may be considered if prolonged neutropenia develops. IV hydration will be maintained to reduce the risk of nephrotoxicity.
Patient Counseling and Follow-Up: Discussed potential chemotherapy side effects, including nausea, hair loss, myelosuppression, and infection risk. Fertility counseling will be provided if applicable. Follow-up is scheduled in two weeks for CBC monitoring and assessment of chemotherapy side effects. A palliative or supportive care consult will be considered if symptoms worsen.