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Peg has PTLD - Post Transplant Lymphoproliferative Disorder. the first line of treatment is to reduce the Immunosuppresent Drugs she is taking. from the heart transplant. There are two drugs she takes for this. One was 700 mg twice a day - it is now 250 mg twice a day. The other was something like 10 mg twice a day and it is now 5 mg maybe once a day. This has reduced the lymph nodes, but not eliminated the tumors completely. The doctor felt that they had been reduced for long enough that it is necessary to try something else.
So the next step is Chemo. He will use a treatment called EPOCH - the drugs involved in this are Prednisone, Vincristine, Cyclophospharnide and Rituxin.
Monday, May 22 - Peg will go to the James and they will put in a PIC line and then she will see Dr. B in the clinic. He will go over some labs and then have her admitted to the hospital. The chemo she will receive will be given in the PIC line over 4 (or 5) days. They start slow and monitor her tolerance and then change as needed. They will add what is needed for whatever comes up - from Tylenol or benedryl to something for an upset stomach. Whatever is needed to keep her comfortable. She will be allowed to have company and do whatever she wants - read, sew, sleep, watch tv etc. they said she should get up and move around though. She will then be released on Friday probably and they have several different treatments for increasing platelets and checking levels every few days after that for 2 weeks. They felt this could be done in springfield. After two weeks, if all is looking good - she will go back in for another treatment a week long again. She has something on June 17, so they may put this off until the 19th. He said he would rather she not be out and about too close to the end of the week stay in the hospital. In the past he has done this treatment 3 or 4 times on PTLD patients, so he is hoping for 3, but a 4th might be necessary. They will schedule a PET scan after the 3rd one to see what the activity of the lymph nodes are to determine if a 4th treatment is needed.