Shedding Light On Lymphoma

A look into the complex blood cancer that affects the lymphatic system and some of the treatment options available.

AsianScientist (Mar. 30, 2023) — Lymphoma is a type of blood cancer that develops in the lymphatic system, an essential part of the immune system that regulates bodily fluids and immune responses. Typically affecting the lymphocytes, a form of white blood cell, this complex disease has numerous subtypes that are broadly categorized as Hodgkin lymphoma or non-Hodgkin lymphoma (NHL) depending on the presence of a specific cell known as the Reed-Sternberg cell.

Between the two categories, non-Hodgkin lymphoma—in which the Reed-Sternberg cell is absent—is more common, with 544,352 new cases (or three percent of total new cancer cases) and 259,793 deaths reported worldwide in 2020. Across Asia, there were 241,270 new cases and 133,407 deaths. In Singapore, NHL was among the top 10 cancers in 2020, with 1,099 new cases reported.

NHL can be further divided into B-cell or T-cell lymphoma and is often assigned either a low or high grade based on how quickly the mutated cell spreads. For example, diffuse large B-cell lymphoma (DLBCL), the most commonly diagnosed subtype, is classified as high grade because it can spread aggressively throughout the lymphatic system in a matter of weeks.

According to the American Cancer Society, the cause of NHL is unclear but several risk factors have been observed. For instance, the likelihood of developing NHL is higher for individuals above the age of 60 and for men than women, although it depends on the NHL subtype. Some studies have also found that exposure to certain chemicals or radiation increases the risk of developing NHL.

NHL symptoms can vary based on the subtype but swollen lymph nodes, or painless lumps under the skin, are typical. Other accompanying symptoms may include weight loss, fatigue, chest pain, easy bruising and more frequent or severe infections due to a weakened immune system.

Globally, blood cancer treatment has advanced significantly in recent years, improving the survival outcomes and remission rates of patients with limited therapy options. The first line of treatment is often chemotherapy, which uses cytotoxic drugs to disrupt the action of rapidly dividing cells. Immunotherapy drugs are also common, which can be combined with chemotherapy or used on their own.

While overall treatment outcomes for patients have improved, the threat of lymphoma can persist as relapses could occur.

“Not all lymphoma patients will achieve a cure, for example, 40 percent of patients with DLBCL may experience relapse after the first line of treatment, prompting the use of salvage therapy with alternative drugs or cell therapy as consolidation therapy,” said Dr. Dawn Mya Hae Tha, Senior Consultant in Haemotology at Parkway Cancer Centre, Singapore.

For patients who relapsed or do not respond to initial treatment, a stem cell transplant may be considered. Before receiving the stem cell transplant, the patient receives high doses of chemotherapy, and sometimes radiation therapy, to prepare the body for transplantation. After that, stem cells are infused into the patient’s bloodstream, and the process of forming new, healthy blood cells to replace the destroyed or diseased cells begins. The stem cells can come from the cancer patient’s own blood (known as autologous transplant) or a suitable donor (known as allogeneic transplant).

If this is also unsuccessful, a third line treatment option could be chimeric antigen receptor (CAR) T-cell therapy. This form of treatment involves first collecting a patient’s white blood cells before separating out the T-cells. The isolated T-cells are then genetically engineered with the CAR gene to produce a specific protein (CAR) that enables the T-cells—now CAR T-cells—to recognize and destroy cancerous lymphoma cells. The modified T-cells are then returned to the patient via infusion.

A biomedical scientist preparing the CAR T-cells in the laboratory.

However, CAR T-cell therapy is a very complex specialist treatment that requires the expertise of a multidisciplinary team—including haemotologists, neurologists, infectious disease specialists, and cell-therapy trained nurses and physicians.

While advancements in cancer treatment are promising, early detection remains the best course of action. It is advisable for patients with potential symptoms of NHL to seek the advice of a physician or other qualified health care provider to receive an accurate diagnosis and support.

The information including, but not limited to, text, graphics, images and other material contained in this article are for informational purposes only. No material in this article is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.

Source: Gilead Sciences Europe Ltd.
This article does not necessarily reflect the views of AsianScientist or its staff.

Asian Scientist Magazine is an award-winning science and technology magazine that highlights R&D news stories from Asia to a global audience. The magazine is published by Singapore-headquartered Wildtype Media Group.

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