Navigating the ups and downs of the lymphoma journey

A lymphoma diagnosis often leaves patients with deep uncertainty. In Singapore, this form of blood cancer ranks among the most common cancers, placing fourth among men and fifth among women. Diffuse large B-cell lymphoma, which accounts for nearly half of all non-Hodgkin lymphoma (NHL) cases, is particularly aggressive and presents significant challenges for both patients and physicians¹. 

“Having spent most of my career treating blood cancers, I have seen the emotional toll a lymphoma diagnosis can take,” shared Dr Lim Zi Yi, medical director and senior consultant at the Centre for Clinical Haematology in Singapore.  

Many patients experience “a roller coaster ride of emotions”, shifting from shock to denial before eventually reaching acceptance. Physicians play a crucial role in guiding patients through this journey, shared Dr Lim. 

NEXT STEPS AFTER A LYMPHOMA DIAGNOSIS

When exploring treatment options, working closely with physicians is key to weighing benefits, managing risks and preparing for possible side effects. Dr Lim emphasised the importance of making informed decisions tailored to each patient’s unique needs, highlighting the resilience needed during the treatment process.

“For most patients, first-line options involve chemotherapy and immunotherapy, typically given in cycles over a few days every three to four weeks,” he explained. Much of this treatment is now administered in an outpatient setting, which most patients prefer. “While chemotherapy side effects such as fatigue, nausea and weakness can sometimes be debilitating, modern supportive care including antinausea medication helps alleviate much of this discomfort,” Dr Lim added. 

Caregivers, too, often grapple with their own emotional and physical struggles, balancing the demands of caring for a loved one while also attending to their own needs and responsibilities. They may experience constant uncertainty, feeling caught in a state of heightened alertness and needing to adjust routines based on the evolving physical and mental condition of the patient². 

WHAT HAPPENS AFTER A LYMPHOMA RELAPSE 

Advances in first-line treatments have made lymphoma increasingly manageable, with NHL patients showing a five-year survival rate of over 74 per cent and approximately 50 per cent of patients with aggressive NHL achieving remission. “However, while more than half of the patients with high-grade lymphoma attain a lasting remission, the prognosis is poorer for patients who relapse or those who do not respond to initial treatments,” said Dr Lim. 

At this stage, conventional options include chemotherapy, followed by a stem-cell transplant, which requires high-dose chemotherapy. “Many patients may not tolerate this approach due to factors such as general fraility, poorer overall fitness or advanced disease progression^3,4,” he explained. 

Even with these interventions, studies show that up to 50 per cent of patients do not respond or relapse again after second-line therapy, demonstrating how difficult it is to manage complex lymphoma cases.

NEW POSSIBILITIES FOR PATIENTS

In Singapore, innovative treatments like chimeric antigen receptor (CAR) T-cell therapy have emerged, offering renewed hope and the possibility of long-term remission for patients with relapsed lymphoma. This therapy is approved for high-grade lymphoma, such as diffuse large B-cell lymphoma, in patients who relapse or remain resistant to treatment within a year of initial chemotherapy.

“CAR T-cell therapy is a custom-made, one-time treatment that modifies a patient’s own white blood cells to harness their immune system to fight certain kinds of blood cancer,” said Dr Lim. 

He noted, however, that two potential complications – cytokine release syndrome and neurotoxicity – may occur, making close monitoring essential throughout the process.

He acknowledged that the treatment journey for cancer patients, especially those facing treatment setbacks, can feel overwhelming. “Remember, you are not alone,” Dr Lim emphasised. “Ask questions and advocate for yourself. Lean on your medical and nursing teams, family, friends and support groups; give yourself the space to process the spectrum of emotions that come with a lymphoma diagnosis. The path may be challenging but help is always available along the way.”

If you or a loved one has been diagnosed with lymphoma or another blood cancer, speak to a doctor to learn more about the treatment options available.

CAR T-cell therapy may not be an appropriate treatment for all individuals and is typically reserved for patients with specific blood cancers who have not experienced success with other therapies. As with any medical procedure, CAR T-cell therapy carries potential risks and side effects. A thorough discussion with a qualified healthcare professional is crucial to determine if the treatment is suitable for your circumstances.

¹Flowers CR, et al. New challenges in the management of diffuse large B-cell lymphoma. Treat Strateg Hematol 2012;2:68-73

²Nemati S, et al. The spiritual challenges faced by family caregivers of patients with cancer: a qualitative study. Holist Nurs Pract. 2017;31:110–7. doi: 0.1097/HNP.0000000000000198

³Henry Ngu et al., Revising the Treatment Pathways in Lymphoma: New Standards of Care—How Do We Choose?. Am Soc Clin Oncol Educ Book 42, 629-642(2022).DOI:10.1200/EDBK_349307

⁴Michael Crump, Sattva S. Neelapu, Umar Farooq, Eric Van Den Neste, John Kuruvilla, Jason Westin, Brian K. Link, Annette Hay, James R. Cerhan, Liting Zhu, Sami Boussetta, Lei Feng, Matthew J. Maurer, Lynn Navale, Jeff Wiezorek, William Y. Go, Christian Gisselbrecht; Outcomes in refractory diffuse large B-cell lymphoma: results from the international SCHOLAR-1 study. Blood 2017; 130 (16): 1800–1808. doi: https://doi.org/10.1182/blood-2017-03-769620