Understanding Lymphoma and Clinical Trials
- Hanna Bird, 24, suffered from night sweats, back and chest pain, weight loss, rashes and persistent coughing for six months before learning she had Diffuse large B cell lymphoma.
- Lymphoma is a type of blood cancer. Blood cancers can affect the bone marrow, blood cells, lymph nodes and other parts of the lymphatic system. The Leukemia & Lymphoma Society reports that every 3 minutes, one person in the U.S. is diagnosed with a blood cancer.
- More specifically, lymphoma is a cancer of the immune system that begins in the white blood cells called lymphocytes. Lymphoma begins when lymphocytes develop a genetic mutation that makes them multiply much faster than normal. This mutation also forces older cells that would normally die to stay alive. From there, the quickly multiplying lymphocytes collect and build up in your lymph nodes, the small glands in your neck, armpits, and other parts of your body.
- The main treatment for diffuse large B-cell lymphoma is a combination of three chemotherapy drugs, a steroid, and a monoclonal antibody. Radiation may also be added. And the success rate with these treatments is about 80% in people with early-stage cancers
- Non-Hodgkin lymphoma patients diagnosed with late-stage cancer or whose cancer returns should ask their care team about clinical trials.
The 24-year-old, who is now cancer free, had suffered from night sweats, back and chest pain, weight loss, rashes and persistent coughing for six months before learning she had Diffuse large B cell lymphoma, an aggressive type of non-Hodgkin lymphoma (blood cancer) that affects the immune system.
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When doctors found the cancer, Bird learned she had a tumor that “took up three-quarters” of her lung and it was stage 4 cancer, news she was revealed to learn because she no longer had to stress about what was causing her to feel sick.
Before doing a biopsy, doctors thought Bird had lung cancer, but further testing revealed she had lymphoma.
Thankfully she was accepted into a clinical trial and was given an immunotherapy non-chemo-invasive drug instead of chemo.
“At my halfway scan my tumor had shrunk by 80%. By September 2022, I had finished chemotherapy all the cancer was gone, which was not normal,” Bird explained. “I am the only person in the UK to have all of their non-Hodgkin’s cancer gone with chemotherapy alone.”
Bird, who is set to get married in September 2023, must now undergo CT scans every 12 weeks to check if the cancer has returned and she hopes to inspire others to follow their gut instinct when they feel something isn’t right.
“Get a second opinion, I went to the same doctor every single time, I think if I had gone to a different doctor I would have been diagnosed a lot sooner,” she advised anyone experiencing persistent symptoms that remain unexplained.
“I went to the doctor three to four times a week – I was so desperate. If you think that something is wrong, request a referral or second opinion by another doctor,” she concluded.
Understanding Lymphoma
Lymphoma is a type of blood cancer. Blood cancers can affect the bone marrow, blood cells, lymph nodes and other parts of the lymphatic system. The Leukemia & Lymphoma Society reports that every 3 minutes, one person in the U.S. is diagnosed with a blood cancer.
More specifically, lymphoma is a cancer of the immune system that begins in the white blood cells called lymphocytes. Lymphoma begins when lymphocytes develop a genetic mutation that makes them multiply much faster than normal. This mutation also forces older cells that would normally die to stay alive. From there, the quickly multiplying lymphocytes collect and build up in your lymph nodes, the small glands in your neck, armpits, and other parts of your body.
What Kind of Lymphoma Do You Have? Why Your Type Matters
It's important to note there are more than 40 different types of lymphoma. Hodgkin lymphoma and non-Hodgkin lymphoma are the main two sub-categories with the latter being more common. Diffuse large B-cell lymphoma (DLBCL) is the most common form of lymphoma.
The type of white blood cells linked to the disease determines the distinction between Hodgkin lymphoma and non-Hodgkin lymphoma. If doctors are unable to detect the Reed-Sternberg cell a giant cell derived from B lymphocytes then the cancer is categorized as non-Hodgkin lymphoma.
You might be at a higher risk for lymphoma if you:
- Have been infected with the HIV or Epstein-Barr virus
- Had an organ transplant
- Have a family history of lymphoma
- Have been treated with radiation or chemotherapy drugs for cancer in the past
- Have an autoimmune disease
Signs of Lymphoma
One thing to note about lymphomas is this type of cancer often creeps in quietly, without symptoms. And even when symptoms do show up, they don't necessarily point directly to cancer. In a previous interview with SurvivorNet, Dr. Elise Chong, a medical oncologist at Penn Medicine, explained that lymphoma symptoms could be difficult to detect.
Sneaky Lymphoma Symptoms Often Lead to a Late Diagnosis
"The symptoms of lymphoma, especially if you have a low-grade lymphoma, often are no symptoms," Dr. Chong explained. "People say, but I feel completely fine, and that's very normal."
People with lymphoma do not always have symptoms, but common signs are:
- Swollen glands in your neck, armpit or groin
- Fever
- Chills
- Night sweats
- Unexplained weight loss
- Feeling tired
- Swelling in your stomach
No matter what, it's important to communicate anything unusual happening to your body with your doctor. Even if there's nothing to worry about, it's good to rule out the possibility of more serious issues.
Diffuse Large B-Cell Lymphoma: A Highly Treatable Cancer When Caught Early
About 1 in 5 people with non-Hodgkin lymphoma have the diffuse large B-cell variety, making it the most common type of non-Hodgkin lymphoma in the United States. This is a fast-growing cancer, but when caught early, treatment success rates are high.
"We never claim a 100% success rate in oncology, because we don't have it, and nothing's 100% in this world other than taxes and death," Dr. Stephen Schuster, medical oncologist at Penn Medicine, tells SurvivorNet. But, he adds, "diffuse large B-cell lymphoma in the early stage is a highly treatable disease."
Treating Diffuse Large B-Cell Lymphoma At An Early Stage
A Drug Combo Approach
The standard treatment for diffuse large B-cell lymphoma is a combination of four drugs that doctors nickname CHOP the chemotherapy drugs cyclophosphamide, doxorubicin, and vincristine plus the steroid prednisone which has been around since the 1970s. Added to that is the newer monoclonal antibody rituximab (Rituxan), which targets a specific protein called CD20 on the surface of cancer cells.
Combining drugs allows the treatment to attack the cancer in different ways. "We can use that to get a remission," Dr. Schuster says.
In people with stage I or stage II diffuse large B-cell lymphoma, where the areas of cancer are next to one another, doctors can also use radiation, "which is the oldest form of therapy for lymphoma," he adds. Radiation uses high-energy x-rays to kill cancer cells.
The success rate with this treatment is about 80% in people with stage I or II cancers. "So you're getting two potentially curative approaches to your disease to get very high success rates," Dr. Schuster says.
Inside the R-CHOP Treatment
You'll get R-CHOP in cycles spaced three weeks apart. Each cycle involves getting the chemotherapy drugs and Rituxan through a vein. Then you'll take prednisone as a pill by mouth.
For stage I or II cancer, the whole treatment should take about three months. "It's three to four treatments with combination chemotherapy and monoclonal antibody therapy, and then a few weeks of radiation therapy and you're done," Dr. Schuster says. You may also receive six treatments of the combination chemotherapy without any radiation.
The Importance of Clinical Trials
Clinical trials are an important tool for cancer patients and their care teams. They help patients access cutting-edge treatments that wouldn't otherwise be available to them. And patients who experience a relapse of their non-Hodgkin lymphoma may be excellent candidates for clinical trials. Or in Bird’s case, it can be an ideal tool for patients amid their first diagnosis of late-stage cancer.
Why Clinical Trials for Diffuse Large B-Cell Lymphoma Are So Important
"When patients have a relapse of most cancers, but particularly lymphoma, often they find themselves in an area where the data is not strong enough to really know exactly what the next best step is," medical oncologist Dr. Michael Jain of the Moffitt Cancer Center tells SurvivorNet.
This group includes patients who may not qualify for treatments such as a stem cell transplant or CAR T-cell therapy, and those who have relapsed after these therapies. "We believe the best care for patients like this is within the confines of a clinical trial," Dr. Jain says.
Why Clinical Trials?
Through clinical trials, patients can access advanced therapies that are otherwise unavailable to the general public, getting top-quality medical care along the way.
"The quality of care is very good in clinical trials." Also, these studies allow people to help shape the future of cancer treatment by testing out potential new compounds and drugs, Dr. Jain says.
For people whose lymphoma has come back after treatment, there are many new therapies that look quite promising. A number of different treatments are available through clinical trials for which patients may qualify, and which could be effective at treating their cancer.
He says the best thing for people who are looking for new therapeutic options to do is to speak with their oncology teams about what clinical trials are available to them.
What Kind of Therapies Do Clinical Trials Use?
Clinical trials use a variety of approaches to therapy. Some might test out new uses for existing chemotherapy drugs or new combinations of chemotherapy. Others look at entirely new approaches to cancer treatment, such as antibody-based drugs.
One new therapy that's currently under investigation in clinical trials is called bi-specific T-cell engagers (or BiTEs). This therapy directs the body's immune cells to the cancer cells. "In addition to recognizing the tumor, it sort of grabs part of the immune system to try and get rid of the lymphoma," Dr. Jain says.
Clinical trials are also studying drugs that reactivate a person's own immune system against their lymphoma. And some investigational treatments bring chemotherapy straight to the tumor to spare neighboring healthy cells. One new therapy, polatuzumab vedotin (Monjuvi), is an antibody-drug conjugate. It travels to and binds to a protein on the surface of cancer cells, and then releases an anti-cancer drug directly into the cell.
There are also new alternatives to CAR T-cell therapy, which genetically re-engineers a person's T-cells to help them find and treat cancer, but is a costly and time-consuming process. "There are a number of other types of cell therapies," Dr. Jain says.
"Exciting" Clinical Trial Options
Dr. Jain calls the range of available clinical trials for non-Hodgkin lymphoma "very exciting." Over the next decade, it will be important for researchers to determine the best drug combinations, and the best time to use these therapies, he adds.
Because of the large variety of clinical trials available, he suggests that patients regularly consult with their care teams. "Even to someone like me, who really studies this all the time, [the options for clinical trials are] quite complex," he says. "I really recommend for patients to consult with an expert on what the next best line of therapy could be."
Contributing: SurvivorNet Staff
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