In an office visit for an annual checkup, a 46-year-old man reports that he has had malaise and intermittent sweats for the past few months but has been able to continue his job as a high school teacher. Two years ago he was treated for stage III diffuse large-cell non-Hodgkin"s lymphoma with six cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) and attained complete remission. He takes simvastatin for hypercholesterolemia and hydrochlorothiazide for hypertension. On physical examination, he has lymphadenopathy: a 3-cm right axillary node and a 2- cm right supraclavicular node. His spleen tip is palpable. Laboratory evaluation shows mild normochromic, normocytic anemia and an elevated serum lactate dehydrogenase level. CT scans of his chest and abdomen reveal additional mediastinal and retroperitoneal lymphadenopathy. What is the best next step in this patient"s management?
A)A 2-week course of oral antibiotics
B)Referral for salvage chemotherapy and autologous stem cell transplantation
C)A repeat physical examination and CT scans in 3 months
D)Referral for treatment with investigational agents
E)A repeat course of CHOP

Question

Quizplus · Accepted Answer

Given the patient's history of stage III diffuse large-cell non-Hodgkin's lymphoma, which was previously treated and now presents with symptoms and findings suggestive of relapse (malaise, sweats, lymphadenopathy, anemia, elevated lactate dehydrogenase, and additional lymphadenopathy on imaging), the best next step is referral for salvage chemotherapy and autologous stem cell transplantation. This approach is indicated for patients who relapse after initial therapy and are in need of more aggressive treatment to achieve remission.

In an Office Visit for an Annual Checkup, a 46-Year-Old