Published on March 24, 2020
Cancer is not a single disease and neither are its various subtypes. Patients who are diagnosed with a B-cell lymphoma have a blood cancer affecting their white blood cells—specifically their B lymphocytes, or B cells. And within the B-cell lymphoma category, there are additional subtypes.
One recently discovered B-cell lymphoma is a non-Hodgkin lymphoma called double-hit lymphoma (DHL). The hallmark of this disease involves a musical chairs game of sorts where parts of genes switch places within chromosomes. B cells are important for immunity, and the genes that cause DHL by rearranging—MYC, Bcl-2 and occasionally Bcl-6—are called onco-genes because they are the fuel that kick-start some cancers.
Harnessing the Power of the Immune System to Treat DHL
Because DHL is a fairly new classification, research scientists are still figuring out the best chemotherapy cocktail for this aggressive cancer. High-dose chemotherapy may be the first line of treatment followed by one of two stem cell transplants:
- autologous stem cell transplant (using the patient’s own cells)
- allogeneic stem cell transplant (using cells from a donor)
These types of procedures bring the patient’s immune system down to about zero immunity in order to enable the transplant to be accepted, not rejected, by the patient’s own system. Patients are usually isolated in a hospital intensive care unit until they slowly build their immunity back up. These highly regulated patient suites are often designed with scrub rooms for doctors and visitors to use before entering the main patient areas to protect the patients from outside germs.
Ongoing research and clinical trials will help experts continue to refine treatment options as they learn more about this fast-growing lymphoma.
Treating B-Cell Lymphomas in the CAR T-Cell Era
CAR T-cell therapy is relatively nascent and very exciting, because it also harnesses the power of a patient’s immune system to fight cancer. Here’s how it works: T cells, which are a type of white blood cell essential to the immune system, are extracted from the patient and re-engineered to produce new receptors called chimeric antigen receptors (CARs). When infused back into the patient, these new receptors enable the T cells, which are now CAR-T cells, to latch onto a specific antigen on the tumor cells and kill them.
It may sound like science fiction, as Dr. Joshua Brody of Mount Sinai Hospital says, but CAR T is the future of precision medicine and is being explored for use in other blood cancers as well.
Patient Success Story Gives Hope to Others
When Dan Symes was diagnosed with diffuse large B-cell lymphoma at age 61, he quickly became very sick and was hospitalized, worrying about the future of his wife and four children as he ran out of treatment options. After participating in a CAR-T clinical trial, however, Dan went into complete remission and is now enjoying his first grandchild. Watch Dan’s inspirational story to learn more about CAR T-cell therapy and to see how it is changing lives.
As cancer research evolves, patients have access to more and better treatment options. For example, some patients may not be eligible for stem cell transplants because they experienced a relapse or other treatment options haven’t worked. For those patients, CAR T might now be an option when previously there was no alternative.
In 2018, the U.S. Food and Drug Administration (FDA) approved tisagenlecleucel (Kymriah)—a CAR T-cell therapy—for patients with relapsed/refractory diffuse large B-cell lymphoma. Because of the relapse these patients are not able to undergo an autologous stem cell transplant, but now they have CAR T as an option.
It’s an interesting time to be watching the outcomes of research that helps patients use their own immune systems, in addition to the therapies being developed with care in research labs, to create new treatment options.
~Lauren Evoy Davis
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