Case 149 – Update 1

 

Our patient is a retired cleaner who lives in a house next to her only daughter and her two grand-children. She is a non smoker and drinks no alcohol. She tells you that her daughter tended to do the shopping since the COVID pandemic but she does her own cooking and washing. She tells you recently she has been very fatigued and has spent most of the day in her chair. Three months ago she was able to do some gardening and could get up a flight of stairs at home without problems. She has lost around 4 kg in weight recently and has a fair appetite. Her BMI is 24.

She lives alone having been widowed some 15 years ago. She has a Cat who she is very fond of and she is anxious to be home as soon as possible. She says she does want to have treatment for her lymphoma as long as it won’t make her have to be in hospital.

She had rheumatic fever as a child and was told she had a leaky heart valve but hasn’t seen a cardiologist for this. She has hypertension and is on Amlodipine 10mg for this. She is also on a statin but denies any previous cardiac events or strokes. She had a cholecystectomy age 40. She is also on a PPI for previous gastric ulcer a few years ago.

She had an echo that shows her Ejection fraction is >55% and she has mild MR.

Her viral screen is negative and her blood tests are unremarkable – FBC: Hb 130, plt 290, neu 2.4, Wcc 4. EGFR 90, LFTs normal, LDH 398 (high).

CT shows likely stage I disease with bulk >7.5cm.

What treatment options does she have?

What would be your preferred treatment option here?

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