June 25, 2015 | by Robin Heffler
When Maryland Governor Larry Hogan announced earlier this week that he has the most common form of non-Hodgkin lymphoma, he was giving voice to the experience of more than 71,000 Americans each year. The announcement came with Hogan's promise to stay in office while undergoing aggressive treatment for the disease.
That promise highlights the advances made against non-Hodgkin lymphoma, as well as the need for additional therapeutic options. In both the delivery of the most advanced possible care, and the creation of new treatment options, City of Hope is a national leader.
The most effective treatment plan for non-Hodgkin lymphoma starts with proper diagnosis, City of Hope experts said. There are many different subtypes of the disease, which is marked by tumors that develop in the immune system’s lymphocytes, or white blood cells. Often, as in Hogan’s case, non-Hodgkin lymphoma is diagnosed in later stages, but it's nevertheless highly treatable; some 70 percent of patients are alive five years after diagnosis.
“To make sure that the correct type of NHL is diagnosed, the first step after the initial diagnosis is having the biopsy reviewed by a reputable hematopathologist,” said Leslie Popplewell, M.D., associate clinical professor and staff physician in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope.
Patients who come to the Toni Stephenson Lymphoma Center at City of Hope enter one of the largest and most successful treatment centers that specializes in both non-Hodgkin and Hodgkin lymphoma. The center offers a state-of-the-art range of therapies.
“We have a dedicated group of clinicians, researchers and administrators all working together to develop new and better treatment for lymphoma, and continue to recruit outstanding and dedicated faculty,” said Larry Kwak, M.D., Ph.D., director of the center.
Advanced treatments that address variations in disease
Popplewell explained that non-Hodgkin lymphoma treatment varies depending on the subtype and other factors. Usually it involves multiple courses of chemotherapy, sometimes using a combination of several drugs, or together with radiation. If a relapse occurs, the patient may receive chemotherapy again.
A stem-cell transplant may be performed if there is no remission or in some cases of relapse. City of Hope's Hematologic Malignancies and Stem Cell Transplantation Institute pioneered innovative stem cell transplant regimens that have improved the cure rate for patients with a variety of blood disorders, including non-Hodgkin lymphoma.
In addition, patients may benefit by participating in one of the many clinical trials conducted at the center as part of City of Hope’s extensive research initiatives.
“Generally, we encourage people to seek out clinical trials, and explore all options before entering into standard-of-care treatment, because there may be something better in development,” Popplewell said.
Leading-edge clinical trials welcome new patients
Currently, she said, several non-Hodgkin lymphoma trials are actively recruiting patients.
One is for patients in the early stages of diffuse large B-cell lymphoma, the subtype contracted by Hogan. The study uses PET-scan findings to determine the course of therapy. As a result, patients who have a very good response to chemotherapy can stop after only four cycles of treatment, rather than the usual six to eight.
Another study is for newly diagnosed patients with that subtype who are in Stage 3 or 4 of the disease. It replaces the current combination of drugs with a newer drug called brentuximab vedotin. Researchers hope to see better remission rates and lower relapse rates with the new treatment.
The center is also on the frontier of developing treatments for patients who have diffuse large B-cell lymphoma that relapsed after prior treatment, or who are in first remission for another non-Hodgkin lymphoma subtype called mantle cell lymphoma. These studies, which are known as CAR T cell trials, use patients’ own “T” cells, natural killers of damaged or infected cells, to kill their cancerous “B” cells, which normally fight infections by producing antibodies when they’re healthy.
“We are just beginning to scratch the surface of the uses for CAR T cells, and other targeted therapies,” Popplewell said. “It is hard to know what the future of lymphoma treatment will be, but the more we learn about the pathways that lymphoma cells use to grow and spread, the more potential targets we have to stop them.”
By the numbers
• Accounts for 4 percent of all cancer cases • Majority of 71,850 new cases each year are at Stage 3 • 19,790 annual deaths
Types of conditions
• Three major types of non-Hodgkin lymphoma: B cell, natural killer cell, T cell • Each type has multiple subtypes Primary symptoms • Enlargement of lymph nodes, spleen or other immune tissue • Unexplained fever • Unexplained weight loss • Itching skin • Fatigue • Night sweats
• Weakened immune system • Certain infections • Over age 60
Sources: American Cancer Society and National Cancer Institute
Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.