Woman, 79, Thought the Rash Was From a Food Allergy, but As Her Health Declined, She Could Barely Walk, Then She Learned She Had Non Hodgkin Lymphoma

“Perhaps it’s a mild reaction to an ingredient that had caused it. I didn’t really think anything of it,” Torkington told Wales Online.

But the rash didn’t go away. In fact, it began to move — appearing, disappearing, and reappearing in new places. Still, she didn’t suspect anything serious.

“Then I noticed it was coming and going and appearing in different places, but I still couldn’t make any connection that anything could be that wrong,” she said.

It wasn’t until a routine blood test showed she was slightly anemic that her clinical instincts kicked in.

“Being a nurse, I was a bit concerned because I knew there was no reason for me to be anaemic,” she recalled.

From there, her health declined rapidly. What began as a quiet concern turned into a full-blown crisis.

“It had all happened so quickly, and I had been so unwell over Christmas that by December 28, I could barely walk out of the hospital doors,” she said.

WATCH: When Caught Early, Diffuse Large B-Cell Lymphoma Is Highly Treatable

Doctors diagnosed her with stage four diffuse large B-cell lymphoma (DLBCL), the most common form of Non Hodgkin lymphoma. For patients like Torkington — especially those with aggressive or relapsed disease — new treatments are offering hope, including cellular immunotherapies that reengineer the immune system to fight cancer.

“I did not know if I was going to survive because my condition was getting worse so quickly. It was scary because you know stage four cancer is not good,” she said.

Torkington began treatment immediately, starting six cycles of Pola-R-CHP chemotherapy — a newer regimen that includes polatuzumab vedotin, an antibody–drug conjugate that targets a protein found on most malignant B-cells.

According to the New England Journal of Medicine, “Diffuse large B-cell lymphoma (DLBCL) is typically treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). However, only 60% of patients are cured with R-CHOP. Polatuzumab vedotin is an antibody–drug conjugate targeting CD79b, which is ubiquitously expressed on the surface of malignant B cells.”

WATCH: Why Clinical Trials for Diffuse Large B-Cell Lymphoma Are So Important

In the Phase III POLARIX trial — a randomized, double-blind, placebo-controlled study — researchers compared pola-R-CHP to standard R-CHOP. Among 879 patients, those treated with pola-R-CHP had significantly better progression-free survival. As the study noted, “patients surviving without progression were significantly higher in the pola-R-CHP group than in the R-CHOP group.” Overall survival at two years was similar in both groups, at around 88%.

Now in remission, Torkington says she feels “well” and is “grateful.”

Understanding Large B-Cell Lymphoma

Large B-cell lymphoma (LBCL) is the most common type of Non Hodgkin Lymphoma, a cancer that starts in white blood cells called lymphocytes. These cells are part of the immune system, and when they begin to grow uncontrollably, they can form tumors in the lymph nodes or other organs such as the spleen, liver, or bone marrow.

The most frequent subtype is diffuse large B-cell lymphoma (DLBCL). It’s considered aggressive, which means it tends to grow quickly — but that also means it often responds well to prompt, effective treatment.

WATCH: Non-Hodgkin Lymphoma: It’s More Than Just One Type

Why It Happens

In most cases, doctors cannot pinpoint exactly why someone develops lymphoma. However, there are some known risk factors:

• Age: It’s more common in older adults, though it can occur at any age.
• Immune system problems: People with weakened immune systems — from HIV, autoimmune diseases, or certain medications — have a higher risk.
• Family history or previous cancers: These can slightly increase risk, though lymphoma isn’t typically inherited.
• Infections: Rarely, chronic infections such as H. pylori or hepatitis C may play a role.

Better Understanding Non Hodgkin Lymphoma

“Non-Hodgkin lymphoma is a big category,” Dr. Julie Vose, chief of hematology/oncology at the University of Nebraska Medical Center, previously told SurvivorNet.

All non-Hodgkin lymphomas begin in white blood cells known as lymphocytes, which are part of your body’s immune system. From there, doctors separate these cancers into types depending on the specific kind of lymphocytes they grow from, B-cells or T-cells.

WATCH: The type of lymphoma you have matters.

Knowing which of these you have can help steer you to the most appropriate treatment.

One way doctors divide up these cancers is based on how fast they’re likely to grow and spread. “The two main classifications I think of in terms of non-Hodgkin lymphoma are lymphomas that are more indolent and those that are more aggressive because those are treated very differently,” Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Institute, tells SurvivorNet.

Once you’ve been diagnosed with non-Hodgkin lymphoma, the next question your doctor will want to answer is whether you have B-cell or T-cell lymphoma. That answer is important because it will help determine your treatment.

B-cells and T-cells are two kinds of lymphocytes. They’re both infection-fighting cells, but they work in different ways.

About 85% of non-Hodgkin lymphomas affect B cells. These cells produce antibodies, proteins that react to foreign substances like viruses or bacteria in your body. The antibodies attach to another protein on the surface of the invading cells, called an antigen, to target and destroy them.

Types of B-cell lymphoma include:

• Diffuse large B-cell lymphoma
• Follicular lymphoma
• Small lymphocytic lymphoma (SLL)/chronic lymphocytic leukemia (CLL)
• Mantle cell lymphoma
• Marginal zone lymphomas
• Burkitt lymphoma
• T-cell lymphomas make up only 15% of non-Hodgkin lymphomas. Unlike B-cells,
• T-cells directly destroy bacteria and other invaders.

Types of T-cell lymphoma include:

• T-lymphoblastic lymphoma/leukemia
• Peripheral T-cell lymphomas
• Cutaneous T-cell lymphoma

What Treatment for Non Hodgkin Lymphoma Looks Like?

Lymphoma treatment largely depends on the nature of your specific diagnosis. For non-Hodgkin lymphoma patients, their cancer is more likely to spread randomly and be discovered in different groups of lymph nodes in the body. Hodgkin lymphoma cancers, on the other hand, are more likely to grow consistently from one group of lymph nodes directly to another.

WATCH: Non-Hodgkin lymphoma treatment options

“There are some lymphomas that are very treatable but not curable,” Dr. Lawrence Piro told SurvivorNet.

Dr. Lawrence Piro is the President and CEO of The Angeles Clinic and Research Institute in Los Angeles, a Cedars-Sinai affiliate. He adds that some lymphomas progress quickly if left untreated.

Non-Hodgkin lymphoma treatment depends on the type, stage, and how fast it grows. People with aggressive non-Hodgkin lymphoma can expect to get a chemotherapy combination called R-CHOP, which is a drug cocktail consisting of chemotherapy drugs plus an antibody drug and a steroid to treat diffuse large B-cell non-Hodgkin lymphoma.

R-CHOP stands for:

• R: Rituximab (Rituxan) is a monoclonal antibody that attaches to a specific protein called CD20, which sits on the surface of B cells. It targets cancerous cells and destroys them.
• C: Cyclophosphamide is a type of chemotherapy drug
• D: Doxorubicin hydrochloride (hydroxydaunomycin) is a type of chemotherapy drug
• V: Vincristine sulfate (Oncovin) is a type of chemotherapy drug
• P: Prednisone is a steroid that lowers inflammation

Patients receiving R-CHOP receive the drug in six cycles that are three weeks apart.

“R-CHOP is a cocktail of drugs. There are five different drugs in that recipe,” Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Institute, tells SurvivorNet.

WATCH: Understanding R-CHOP treatment.

R-CHOP side effects can include:

• Tiredness and weakness
• Hair loss
• Mouth sores
• Bruising and bleeding
• Increased risk of infection
• Appetite loss and weight loss
• Changes in bowel movements

Immunotherapy and targeted therapy are also treatment options for Non Hodgkin Lymphoma patients.

Rituximab (Rituxan) was the first immunotherapy drug approved to treat some forms of non-Hodgkin lymphoma. “Rituximab is the immunotherapy that has been approved the longest, and we have the most experience with lymphoma,” Dr. Chong tells SurvivorNet.

Rituxan has side effects, including fever, chills, swelling under the skin, itching, and mild shortness of breath.

Brentuximab vedotin (Adcetris) is a relatively new targeted treatment for non-Hodgkin lymphoma and Hodgkin lymphoma. This drug is an antibody-drug conjugate that combines an antibody (a type of protein that recognizes foreign substances in the body) with a drug that treats cancer. It uses a particular protein to deliver medicine directly to the cancer cell.

Non-Hodgkin lymphoma can also be treated with radiation, which aims beams of intense energy at the cancer to stop cancer cells from growing and dividing.

Questions for Your Doctor

If you are dealing with a lymphoma diagnosis, it’s important to ask your doctor a series of questions so you will have an idea of what your next steps will look like. To help you during this difficult time, SurvivorNet has some questions to kickstart your conversation with your physician.

• What type of lymphoma do I have?
• What does my pathology report say about my diagnosis?
• Should I get a second opinion before I explore possible treatment options?
• Based on my diagnosis, what do you anticipate my treatment path?
• What common side effects should I expect when I begin treatment?
• Will I be able to continue working and performing normal daily activities during treatment?
• Where can I get help working with the insurance company regarding treatment costs?
• Who do you recommend I get mental health help from during my treatment?

Learn more about SurvivorNet's rigorous medical review process.

---