Initially this 65 year old patient was
seen at the Mayo Clinic, Jacksonville in July,1998, for development of left supraclavicular
adenopathy.He had a history of nodular gastritis with intestinal metaplasia. In addition ,
he had outside CT scans showing extensive intraabdominal adenopathy (CT scans done
in Venezuela).He underwent biopsy of the left supraclavicular lymph node on July 9,1998,
which revealed a polymorphic large cell lymphoma. This Bcell neoplasm expressed CD45
and CD20, but not CD3. In addition, there may have been a low grade lymphoma of small
lymphocytic type and some relation between this and his prior history of gastrointestinal
lyphocytic infiltrate. Thus, the more aggressive lymphoma may represent a transformation
of the lower grade process. Additional staging included biopsy of the bone marrow, which
was negative. Several blood tests were performed revealing only a mild anemia, the rest
was reported as normal or negative.
On July 24, 1998 he began a series of
17 IPT treatments. The lymph node on the left side of the neck measured 44 mm. The morning
of the 3rd IPT treatment (7/30/98), the lymph node measured 39 mm (see photo 1 at right).
On August 31,1998, on the morning before the 13th IPT treatment, the lymph node
measured 9 mm (see photo 2).
He came back for 4 additional IPT on 10/12; 10/16; 10/19 and 10/23. On
10/23 there was no measurable lymph node (see photo 3 ). He had a CT scan done in South
America that reported "significant improvement in the neck tumor, and also the
abdominal lymph node showed signs of possible necrosis but significantly reduced in
IPT treatment history:
7/24, 7/27, 7/30, 8/3, 8/7, and 8/10
PO (oral): Lanzoprazol 15mg ; BComplex 1 tab
IM (intramuscular): Liver extract 1ml; Dexametasone 2mg.
IV (intravenous): Vit C 1gr; Metronidazol 150mg; Iron 100mcg; Cyclophosphamide
40mg; Doxorubicin 1mg; Vinblastine 1mg
8/14; 8/17; 8/21; 8/24; 8/28; and 8/31
IM: Liver Extract 1ml
IV: VitC 1gr; Iron 100mcg; Dexamethasone 2mg; Metronidazol 150mg; Meloxicam 15mg;
Doxorubicine 1mg; Mexathe 2mg; Vinblastine 1mg and Cyclophosphamide 50mg.
10/12; 10/16; 10/19; and 10/23
Same as first round.
Interim medication: Clorambucilo 6mg PO; LEGALON 3bid; AGIOLAX 1 bid and Meloxicam 7.5mg.
Today (10/23/98), the patient left my office happy, with no visible node on the neck. He
plans to return in February of 1999.
Follow-up Note: As of February 1999 the patient still feels
well, although there are still signs of disease in his blood count. He has not been
able to return to Dr. Perez Garcia 3 to complete his course of treatment.