Every year in the USA alone, more than 18,000 people are diagnosed with diffuse large B-cell lymphoma. This disease accounts for 40% of all non-Hodgkin’s lymphoma cases in the world. The risk of getting sick increases with age, but in the last decade this type of cancer has become more common in children and adolescents. You can read about the modern methods of diffuse B-cell lymphoma in this article.
What is diffuse large B-cell lymphoma?
Diffuse B-Cell Lymphoma (DLBCL) is one of the most common blood cancers. It affects the cells that usually protect the body from infections and pathogens. The main symptom is an increase in the size of lymph nodes.
Doctors can detect lymphoma by examining the blood sample through a microscope. B-lymphocytes affected by cancer are larger than normal, and unlike them, don’t tend to stick together.
B-cell lymphoma is caused by a mutation in immune cells, specifically on three separate locations of DNA. The more mutations, the harder it is to treat this type of cancer.
The average survival rate for diffuse large B-cell lymphoma is 71%.
Depending on the appearance, behavior, and type of affected protein, DLBCL is divided into 5 subtypes:
primary diffuse large B-cell lymphoma;
primary cutaneous diffuse large B-cell lymphoma;
T-cell/histiocyte-rich B-cell lymphoma;
Epstein-Barr virus-positive diffuse large B-cell lymphoma;
diffuse large B-cell lymphoma not otherwise specified.
Diffuse B-cell lymphoma is an aggressive disease that quickly affects the human body. Because of this, it is often diagnosed at late stages.
Most patients suffering from this type of cancer are over 60 years old. It occurs a little more frequently in men.
Risk factors for diffuse B-cell lymphoma:
Autoimmune diseases (rheumatoid arthritis, lupus);
Prolonged inflammatory processes;
Past lymphoma;
HIV;
Hepatitis C;
Organ transplantation;
Relatives who have had lymphoma;
Being overweight in adolescence.
Story of Cheryl Williams
Cheryl Williams was a regular retiree from Chicago, who used to work as an early childhood educator. Cheryl’s life changed dramatically in 2011 when she was diagnosed with diffuse B-cell stage 4 lymphoma at a doctor’s appointment.
Thanks to the quick reaction of the doctors, as well as the support of family and friends, Cheryl managed to overcome this disease. She underwent chemotherapy prescribed by her oncologist. Every time she needed a scan or blood test, she was anxious to hear the worst news. The day finally came when the doctors told Cheryl she was in remission. Her body was free of cancer.
After remission, patients need to undergo regular check-ups for the next 5 years. This is necessary so that doctors can detect the return of cancer in time. After that, the risk of recurrence is minimal.
In Cheryl’s case, that’s exactly what happened. Before the third anniversary of her recovery, she found out that lymphoma was back. The disease was found on a routine check-up, after which the woman had to undergo an ultrasound and chest biopsy. Labs confirmed it was the same type of cancer.
Cancer patients with relapsed diffuse large B-cell lymphoma are less likely to recover. This type of cancer is often resistant to usual chemotherapy.
Lucky for Cheryl, she was able to beat cancer for the second time. She underwent a course of heavy chemotherapy and had a bone marrow transplant.
It’s been five years since then. Today Cheryl is happy, and most importantly, perfectly healthy.
What is the usual treatment of large diffuse B-cell lymphoma?
The main treatment for diffuse B-cell lymphoma is chemotherapy. The patient takes drugs that are toxic to malignancies. Because of those, cancer cells stop multiplying and die.
Chemotherapy is the name of a large group of drugs. For each type of cancer, there are different chemotherapy courses. Among them, the doctor chooses the best one. The selection of a specific protocol depends on the type and stage of cancer, age of the patient, state of health. The doctor selects a combination of drugs that would give maximum results with minimal side effects.
Chemotherapy |
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Consultation with an oncologist |
Personal approach |
Fewer side effects |
Modern protocols |
Diffuse large B-cell lymphoma on early stages is treated with 3-6 cycles of chemotherapy, carried out on intervals of 21 days. Between medications, patients have rest periods, during which the body recovers its strength.
In stages 3-4, the patient may need more than 6 cycles of chemotherapy. Recurrent cancer is more difficult to treat, so doctors use more aggressive methods.
Usual chemotherapy is only taken once a week. Intensive courses require an outpatient stay for 5-7 days. The medicine enters the body gradually, thus reducing the toxic effect.
The effectiveness of chemotherapy for diffuse large B-cell lymphoma is 60-80%.
Modern chemotherapy abroad has fewer side effects and is more easily tolerated by patients.
The international prognostic index score
International Prognostic Index – a system that allows doctors to determine the patient’s risk of relapse. The index is formed on the basis of:
The patient’s age;
Their state of health;
Stage of the disease;
Normal daily activity function;
Presence of metastases;
The blood level of lactate dehydrogenase.
The higher the score on the prognostic index, the higher the risk of recurrence.
Bone marrow transplantation
If chemotherapy does not help the patient, doctors use bone marrow transplants.
The bone marrow is located in the tubular bones. It creates blood cells, including immune cells. During the transplant, a person is given healthy cells instead of the old ones. There are three types of procedure:
autologous (using the body’s own cells);
allogenic from a related donor;
allogenic from the donor bank.
BONE MARROW TRANSPLANTATION |
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Finding a donor in a month |
Bone marrow biopsy |
Bone marrow transplantation surgery |
3-month rehabilitation in the hospital |
In patients suffering from lymphoma, the bone marrow is too damaged for autologous transplantation. Their only option is an allogenic transplant.
Patients from third world countries prefer to undergo bone marrow transplantation in foreign clinics. Compared to domestic hospitals, they have a higher success rate.
Before the transplantation, doctors need to destroy cancer-infected bone marrow cells. This is usually done with an intensive course of chemotherapy.
When selecting a country, it is important to pay attention to the available options for the procedure. Autologous transplantation is possible in all clinics that practice bone marrow transplantation. But not everywhere transplantations from relatives are allowed or there is access to the international donor base.
As a result of bone marrow transplantation, a person loses immunity for a while, so sterile hospital conditions are very important for the recovery period.
CAR-T therapy
CAR-T therapy is considered the most promising alternative to bone marrow transplantation and the biggest breakthrough in oncology in recent years. James Allison and Tasuku Honjo received the Nobel Prize for its discovery in 2018.
CAR-T method is a type of immunotherapy. Its essence is that the immune cells – T-lymphocytes – are extracted from the human body. In a specialized laboratory, they are modified to recognize and destroy cancer cells. Once in the bloodstream, the T-lymphocytes begin to fight against malignancies.
CAR-T is particularly effective against lymphoma in children and adolescents.
Before the invention of therapy, people with chemotherapy-resistant lymphoma had an overall survival of six months. With this invention, they can have a normal life expectancy.
In some cases, CAR-T therapy can cause side effects: cytokine release syndrome (symptoms similar to a cold) and neurological toxicity. If this happens, the doctor prescribes additional treatment.
CAR-T therapy is used if conventional treatments have proven ineffective, but it is more expensive than bone marrow transplants.
Bispecific T-cell engagers (BiTEs)
Another type of immunotherapy, effective in the treatment of diffuse B-cell lymphoma, is BiTE-therapy. As in the previous method, it involves transforming T-lymphocytes. However, instead of extracting them from the patient, changes occur in the body itself. The substance that is injected into the blood “glues” lymphocytes to cancer.
The advantage of this method is that it does not require access to high-tech laboratories. This makes treatment faster and cheaper.
This method has already been tested on groups of patients with diffuse B-cell lymphoma. Previously they underwent high-dose chemotherapy and CAR-T therapy to no result. BiTE therapy has worked in 89% of cases.
So far, this method is in the trial phase. If it successfully passes all stages and receives FDA approval, BiTE-therapy will be available in many foreign clinics.
Where is diffuse large B-cell lymphoma treated abroad?
Many foreign clinics specializing in oncohematology have a high survival rate. Destinations that are popular among patients from third-world countries are Germany, Israel, Spain, Turkey, India, and South Korea.
The price of treatment depends on many factors, primarily the stage of the disease and the need for bone marrow transplants. The patient’s condition, the level of the hospital and the doctor, the price of medication, etc. also affect the final cost.
In Israel, doctors Odeliya Gur and Levin Dror, who practice at the Ichilov clinic, have a good reputation. In addition, the doctors at this hospital have extensive experience in the treatment of childhood cancer.
Country | Chemotherapy cost |
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Germany | from €2,500 per course |
Israel | from $2,000 per course |
Spain | from €2,000 per course |
Turkey | from $1,500 per course |
India | from $1,000 per course |
South Korea | from $2,000 per course |
In Spain, lymphoma is treated in the centers of Quironsalud, Teknon or the University Clinic of Navarra. The most famous specialist in the country is Dr. Emili Montserrat.
In Turkey, many hospitals specialize in the treatment of non-Hodgkin’s lymphoma – Liv, Koç, Memorial, Medicana, Medical Park. One of the advantages of treatment in Turkey is that the price is 20-40% lower in comparison with Israel and Germany. Yet, doctors use the same equipment and protocols, and the hospitals have quality certificates and are recognized by the world medical community.
Resume
Diffuse large B-cell lymphoma is a type of blood cancer that is characterized by rapid and aggressive growth. That’s why it’s often detected at late stages.
The usual treatment for DLBCL is chemotherapy. For stage 4 lymphoma or a relapse, bone marrow transplantation from a donor may be used.
Alternative methods of treatment like immunotherapy, in particular – CAR-T therapy are gaining popularity. It is most often used when conventional therapies have proved powerless. BiTE is another promising type of immunotherapy, which is currently undergoing medical trials.
The efficiency of treatment of diffuse B-cell lymphoma with modern methods can reach 89%.
If you are interested in treatment of diffuse B-cell lymphoma or you have any questions, please leave your request on MediGlobus website. Our coordinators will contact you and help you with the selection of the clinic and organization of the trip.
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