Microsoft founder Paul Allen died of non-Hodgkin’s lymphoma at age 65. Allen founded Microsoft along with Bill Gates. Allen had been treated for non-Hodgkin’s lymphoma (NHL) nine years ago, and said earlier this month his cancer had returned and he was undergoing treatment. His first bout with the disease came in the 80s, when he was just 29 years old.
Both Hodgkin’s and non-Hodgkin’s lymphoma are diseases of a “family of white blood cells known as lymphocytes, which help the body fight off infections and other diseases.” Non-Hodgkin’s Lymphoma is much more common than Hodgkin’s and is typically diagnosed at an advanced stage, while Hodgkin’s is often caught early.
Here are a few statistics on non-Hodgkin’s lymphoma:
- The number of new cases each year is nearly 75,000 with nearly 20,000 deaths
- Non-Hodgkin’s lymphoma is the most common blood cancer in adults
- About half of patients are age 66 or older.
- Rates for new cases of NHL have been falling over the last 10 years.
- Non-Hodgkin’s lymphoma is the ninth most common cause of cancer death.
- The five year survival rate is 71%
And non-Hodgkin’s lymphoma isn’t just one disease. Dr. Jennifer Amengual, a lymphoma specialist at NewYork-Presbyterian/Columbia University Medical Center says “NHL is a complex group of diseases comprising of nearly 80 different subtypes.”
There are many factors that contribute to predicting prolonged survival in patients with NHL “including the general health of the patient when they are diagnosed, the subtype of NHL and its biological features,” Dr. Amengual says.
As for treatment, Dr. Amengual says “all subtypes of NHL are highly treatable and treatment approaches can range from active surveillance, to aggressive combination chemotherapy, to oral medications aimed at targeting specific pathways driving disease growth.” For patients with more serious forms of the disease autologous stem-cell transplantation has been used.
While we do not know where Allen was treated, the Paul G Allen Foundation provided a $5 million grant to the Fred Hutchinson Cancer Center. Fred Hutchinson is where Nobel Prize winner, the late Dr. Donnall Thomas did the research that lead to bone marrow transplantation for blood cancers – which is used to treat patients with non-Hodgkin’s lymphoma who do not respond to other therapy or have relapsed.
There are two kinds of NHL: aggressive, which grows fast and can be life threatening, and indolent, which grows slowly but people may have it for many years.
The most promising new therapy for aggressive NHL is CAR-T cells, according to Dr. Leo Gordon, Director of the Lymphoma Program at Robert H. Lurie Comprehensive Cancer Center of Northwestern University. NHL was one of the first cancers where CAR-T treatment was tried. CAR-T therapy involves removing T-cells from the body, manipulating them in a lab by genetically modifying the cells, and then growing them in large numbers. The cells are then armed to attack lymphoma cells and are reinfused back into the body. These new cells seek out and destroy the lymphoma. Dr. Gordon says “50% of patients with aggressive NHL treated with CAR-T survive long-term.”
For indolent NHL, Dr. Gordon says that targeted therapy has been the most successful. But checkpoint inhibitors, an immune therapy proven effective in some solid tumors, have not been as promising in NHL.
New treatments for non-Hodgkin’s lymphoma will come out at the American Society of Hematology annual meeting this December. Dr. Amengual says “watch for the results of large phase 3 studies evaluating the addition of targeted therapies to chemotherapy, new ways to harness the immune system with new and improved CAR-T strategies, and novel therapeutics aimed at targeting newly identified pathways driving lymphoma.”