areas in the liver which were thought to represent lymphomatous infiltrates. There was also 14 cm splenomegaly. We elected not to do a lumbar puncture. He was started on cyclical chemotherapy with Prednisolone, Adriamycin, Cyclophosphamide, Etoposide, Bleomycin, Methatrexate (PACE-BOM). This is a regime of combination chemotherapy; in the first week prednisolone is begun (and continued throughout the course) together with adriamycin, cyclophosphamide and etoposide, all of which are myelosuppressive. In the second week bleomycin, vincristine (=0) and methotrexate are given; this regime of alternating drugs is continued for 12-16 weeks. He received three 2 week cycles over 9 weeks; the course was delayed for a week half way through because of bone marrow suppression. During this treatment he had oral-mucositis, total alopecia, recurrence ofperianal herpes infection, and he also required a brief admission for blood transfusion. The patient felt he had a marked reduction in his quality of life and he resented being tied to the hospital to such an extent. In mid-July, half way 284 on 27 April 2019 by guest. Protected by copyright.