The hematology department at the VUmc.
Today I met with the hematologist. In an hour-long meeting, we discussed the treatment options. I summarized the follow-up process in the flowchart below. What he told me was that the biopsy samples were very difficult to interpret and that the experts had never encountered anything this before. Even though the biopsy samples showed no clear “monoclonality” this could not be excluded (cancer cells are clones of a single cell, therefore monoclonality means cancerous). He couldn’t rule out, that after stopping with the Dexamethasone, the lesions would grow again. Of course, the hope is that the lesions continue to shrink, without the help of steroids. This could be a sign that a healthy immune system (which should turn back to ‘normal’ after having stopped the fingolimod -MS medication-, is able to clean up the access of lymphoid cells. Treatment will depend on what will happen in the coming month(s).