New Therapies Give You More Options
- The first treatment for diffuse large B-cell lymphoma is usually a combination of drugs known as R-CHOP
- This treatment cures about 60% of people who get it
- People who aren’t cured can get more chemo, a stem cell transplant, or a new treatment called CAR T-cell therapy
Fortunately, the bounty of new treatments that have come out in recent years have given hope to people who didn’t respond the first time around. Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Center, says she has good news for worried patients. “If they fall into that subgroup of patients who don’t have the response that we’re hoping for, or if their disease comes back after an initial remission, we do have other treatments,” she tells SurvivorNet.
Treatment — Step 2Read More
First, you’ll get high doses of chemotherapy to get rid of the damaged white blood cells. Then you get new, healthy stem cells — either from yourself or a donor — to repopulate your bone marrow. After a couple of weeks, the stem cells will start to make healthy new blood cells.
Because chemotherapy is part of the stem cell transplant, this treatment works best if your cancer is sensitive to chemotherapy. So you probably won’t get a stem cell transplant unless your cancer is still sensitive to chemotherapy, Dr. Crombie says. But if you are responsive to chemotherapy, adding the stem cell transplant could put you into a lasting remission, or even cure your lymphoma.
What happens if a stem cell transplant doesn’t keep your cancer at bay, or your cancer isn’t sensitive to the salvage chemotherapy?
Treatment — Step 3
If the stem cell transplant doesn’t put you into remission, your cancer comes back afterward, or your cancer doesn’t respond to salvage chemotherapy, there is a new treatment that Dr. Crombie refers to as a “breakthrough.” It’s called chimeric antigen receptor (CAR) T-cell therapy.
“That is a novel therapy where a patient’s own immune cells, called T-cells, can be taken from the body and engineered in the lab,” she says. It’s sometimes referred to as a “living therapy,” because it uses actual living cells.
T-cells are the immune cells that help your body fight off germs. During this treatment, your doctor first separates out the T-cells from a sample of your blood. Those cells are then altered in a lab to make them produce special proteins — chimeric antigen receptors — on their surface. Then they’re multiplied, and millions of these cells go back into your body. Once there, the new fighter T-cells attach to a protein on the surface of cancer cells, and attack the cancer.
CAR T-cell therapy “is also an exciting option for patients who haven’t been able to respond to chemotherapy before, or have had their disease come back despite prior therapy,” Dr. Crombie says.
Now, researchers are investigating whether giving patients CAR-T cells earlier in treatment might keep their cancer away better than chemotherapy and stem cell transplant. The answer to that question is still unknown. “We’ll have to await the data to see which is the better second choice in the future,” Dr. Crombie tells SurvivorNet. Researchers are also studying the effectiveness of CAR-T cell therapy in other types of less aggressive non-Hodgkin lymphoma.