The lymphatic system is part of our immune system and has important roles, one of which is the transport of lymphocytes, the white blood cells. There are two types of lymphocytes: T cells and B cells and each fights infections in a slightly different way.
Cancer of the lymphatic system caused by uncontrolled division of lymphocytes is called lymphoma and it is the eighth most common type of cancer. The incidence of lymphoma increases with age and is slightly more common in men. There are over 85 types of lymphoma and they can be divided into two groups: Hodgkin’s lymphomas and non-Hodgkin’s lymphomas. Over 90% of lymphomas are non-Hodgkin’s lymphomas and differ in their course and course of treatment.
Some types of lymphoma have a slow course, which means that the symptoms of the disease can appear even after years. There are also aggressive types of lymphoma with complications that appear within days and weeks to months from the moment the symptoms appear. Most patients with aggressive lymphoma are at an advanced stage of the disease at the time of diagnosis.
Among non-Hodgkin’s lymphomas the most common type is DLBCL lymphoma (Diffuse Large B Cell Lymphoma“”, Developed by Dr. Ohad Binyamini from the Meto-Oncology Institute at Sheba Medical Center – Tel Hashomer. “It accounts for about a third of all adult lymphomas. It is an aggressive disease in which the cancer cells are large type B lymphocytes and the disease can develop in any organ in the body.”
According to Dr. Binyamini, one of the first symptoms of aggressive lymphoma is a lump that grows rapidly in the lymph nodes. Sometimes the lump can also appear outside the glands. As the disease progresses, the infected glands grow and the disease spreads and causes damage to vital organs. Weight loss, fever and multiple sweats.
The patient diagnosed with lymphoma is evaluated by a specialist hematologist. “The evaluation includes examination and evaluation of the glands, blood tests and imaging (PET CT“,” Explains Dr. Binyamini, “when the goal is to assess the spread of the disease and the patient’s ability to cope with the treatments. The median age is 64, an age in which most people have background diseases.”
Existing treatment protocol: cautious optimism alongside the desire to strive for more
Despite the rapid course of DLBCL lymphoma, most patients today can be cured. The standard treatment protocol includes a combination of chemotherapy drugs with antibody-based biologics. The antibody attaches to the lymphoma cells and leads to the destruction of the cell, thereby improving the effectiveness of the chemical treatment. This treatment protocol allows about two-thirds (between 60-75 percent) of patients with DLBCL to be cured after the first round of treatment. The patient’s age and the existing background diseases that allow him to withstand intensive care.
To cure the disease, it is important first of all to achieve complete remission: a condition in which after treatment no evidence of the disease can be seen even through the most sensitive tests. If the complete remission has already been achieved in the first round of treatments, the chances of a cure are extremely high. This condition is true for most patients, but still in 10% of cases the disease does not respond at all to treatment and in about a third – the disease responds first, but later recurs and progresses. If a complete response is not achieved or the disease recurs, it is necessary to give another additional treatment. Young or older patients in good physical condition whose disease has recurred will usually undergo a self-bone marrow transplant to prevent further recurrence.
Recurrent disease is more difficult to cure. Therefore, in order to try to achieve remission among as many patients as possible in the first round of treatments, many studies are conducted in which an attempt is made to increase the intensity of treatment by increasing doses or by different combinations of chemical and biological drugs.
One of the treatments available for DLBCL patients with recurrent disease is a drug coupled to the drug. “In fact, it is chemotherapy that is attached to an antibody that is targeted to act specifically against the cancer cells. This method of treatment allows for a better response to treatment while reducing side effects.”
“In recent years, new therapeutic technologies have been developed that expand our treatment options for patients,” continues Dr. Binyamini. This method is called CAR–T (Chimeric antigen receptor T Cell therapy). A hybrid is made between a T cell from the patient’s immune system and a specific gene that produces a receptor on the surface of the engineered cell, which is able to identify the lymphoma cells as a foreign body. The new (engineered) cell is replicated in the cell culture and returned to the patient in an infusion, they identify the lymphoma cells and destroy them in a controlled manner, with minimal damage to the healthy cells. This treatment entered the health basket as early as 2019 in order to help patients who have no other treatment options left to offer them, “explains Dr. Binyamini.
When the immune system is the key to effective healing
Many of the advanced therapies currently available work as such by activating the immune system in a targeted manner against the cancer cells. Other treatments based on this principle, such as antibodies that know how to bind simultaneously to both cancer cells and T cells of the immune system and cause targeted and increased destruction of cancer cells, are used in various hematologic cancers and are also being studied in lymphoma.
“Promising results were presented at the ASH conference – the annual American Hematology Conference that ended last week,” adds Dr. Binyamini, “results that may in the future change the therapeutic paradigm in DLBCL that has existed for 20 years.”
“Technological advances in medicine are leading us to the cure of more and more cancers. The latest innovations in hematology are at the forefront of cancer treatment,” concludes Dr. Binyamini. “More patients also have recurrent disease.”
It should be emphasized that the choice of possible treatment is up to the decision of the therapist who registers the prescription in consultation with the patient.. The information is as of December 2021. Learn more ,The attending physician should be consulted. Public service. Submitted under the auspices of Roche Pharmaceuticals (Israel) Ltd.“M.