Understanding Treatment Options For Non-Hodgkin Lymphoma
- Govind Sandhu, Head of Global Music Partnerships at TikTok, has revealed his recent swollen knee and body aches, which followed a marathon he ran in, turned out to be an aggressive stage of Non-Hodgkin’s lymphoma. Now he’s sharing his story to inspire others to get checked and spread awareness for lymphoma.
- Lymphoma is a cancer of the immune system that affects infection-fighting cells called lymphocytes. Non-Hodgkin lymphoma is more common than Hodgkin lymphoma, and it typically starts later in life. Common symptoms of this disease include fever, night sweats, weight loss, and fatigue.
- Treatment for non-Hodgkin often includes chemotherapy, radiation, immunotherapy, and targeted therapy.
- SurvivorNet experts say using a chemotherapy combination called R-CHOP [the type of treatment Sandhu is getting] is an effective treatment for aggressive non-Hodgkin lymphoma. It stands for Rituximab (Rituxan) a monoclonal antibody, Cyclophosphamide (a type of chemotherapy drug), Doxorubicin hydrochloride (hydroxydaunomycin – a type of chemotherapy drug), Vincristine sulfate (Oncovin – a type of chemotherapy drug), Prednisone (a steroid).
- Other effective treatments include targeted therapy which works by using a special protein to deliver medicine directly into the cancer cell designed to kill it.
The 38-year-old influencer, who took to his social media accounts this month to explain how he hasn’t been feel well over the past six weeks, said he felt his body go “downhill” just one day after competing in the Sydney Half Marathon in May.
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Sandhu, whose father passed away during the continued, “And after multiple doctors visits, blood tests, ultrasounds, CT scans, PET scans, tissues biopsies and blood work, they were able to get a pretty good, comprehensive overview of where things are at. But there’s also been some complications, as they found some abnormalities just above my pancreas and above my heart.
“But it looks like, fingers crossed, the heart is ok and whatever there is above the pancreas, at the end of the day, that will need to get zapped – and if it’s cancer, the chemo, which I will start soon will be aggressive.”
He insisted “from here on out” he’s moving forward with no negativity, just a positive outlook on his cancer journey.
In a followup video, shared on June 12, Sandhu said he started dat one of chemo.
He captioned the post, “First cycle on RCHOP. Took about 6 hours (first sitting is the longest so they can control the dosage). 1 cycle every 21 days x 6 cycles from here on out (all things going to plan). 2 days in but usually takes longer for initial side effects. Happy to have started the long journey ahead tbh [to be honest].”
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In an effort to be honest about what he’s going through, he wrote alongside his initial post, “I’m sharing for my own healing & outlet and hopefully putting good vibrations & useful info into the world through the many highs & lows which there will be many.
“I appreciate it might not be for everyone which is totally fine. If there are any specifics you want covered along the way or need context drop it in the comments & I’ll try to come back to that in time. Long road ahead, but this won’t be the end of my story, it can’t be! I’m 38 years old, lived the most blessed life to date & have so much more to live for.”
Sandu, whose dad passed away from cancer during the Covid-19 pandemic, concluded, “Life is beautiful, I am lucky & grateful for what I have. The mission continues.”
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Understanding Lymphoma
Govind Sandhu is battling non-Hodgkin lymphoma, one of the two most common types of lymphoma.
Lymphoma is a cancer of the immune system that affects infection-fighting cells called lymphocytes. And there are more than 40 different types of lymphoma.
Sneaky Lymphoma Symptoms Often Lead to a Late Diagnosis
“Lymphoma is split up into a number of different categories,” Dr. Elise Chong, a medical oncologist at Penn Medicine, previously told SurvivorNet.
“The first distinguishing breakpoint, if you will, is non-Hodgkin lymphoma versus Hodgkin lymphoma,” she added, “and those sound like two different categories. But non-Hodgkin lymphoma comprises the majority of lymphoma, and Hodgkin lymphoma is a single specific type of lymphoma.”
Hodgkin lymphoma has distinctive, giant cells called Reed-Sternberg cells. The presence of these cells, which can be seen under a microscope, will help your doctor determine which of the two lymphoma types you have.
Expert Resources On Non-Hodgkin Lymphoma
- All About Biopsies to Diagnose Non-Hodgkin Lymphoma
- All About Follicular Lymphoma: A Common Type of Non-Hodgkin Lymphoma
- Bispecific Antibodies Deliver One-Two Punch to Non-Hodgkin Lymphoma
- Non-Hodgkin Lymphoma: It’s More Than Just One Type
- Could New Non-Hodgkin Lymphoma Drugs Mean Less Chemo in the Future?
- Could Weed Killer or Radiation Exposure Increase Your Risk for Non-Hodgkin Lymphoma?
- CAR-T Therapy is a Game-Changer for Common Type of Non-Hodgkin Lymphoma
There are a few other important differences between non-Hodgkin lymphoma and Hodgkin lymphoma to note. For one thing, non-Hodgkin lymphoma is much more common. And you’re more likely to be diagnosed with it after age 55. However, people usually develop Hodgkin lymphoma at a younger age.
It should be noted that another difference between these two types of lymphoma is that non-Hodgkin lymphoma is more likely to spread in a random fashion and be found in different groups of lymph nodes in the body, while Hodgkin lymphoma is more likely to grow in a uniform way from one group of lymph nodes directly to another.
These two different types of lymphoma behave, spread and respond to treatment differently, so it’s important for you to know which type you have.
Age, Race, and Exposures Might All Factor Into Lymphoma Risk
Treating Non-Hodgkin Lymphoma With R-CHOP
Non-Hodgkin lymphoma treatment depends on the type of lymphoma, the stage, and how fast it is growing. People with aggressive non-Hodgkin lymphoma can expect to get a chemotherapy combination called R-CHOP, which is a drug cocktail consisting of chemotherapy drugs, plus an antibody drug and a steroid to treat diffuse large B-cell non-Hodgkin lymphoma.
Treatment for aggressive B-cell lymphoma is complex, in large part because there are so many different types of B-cell lymphomas. The best treatment choice for you depends largely on the type of lymphoma you have and the stage of your disease. One of the most effective regimens available for aggressive B-cell lymphoma is a drug combination called R-CHOP, which Sandhu is getting.
“R-CHOP has been a standard regimen treatment for aggressive non-Hodgkin lymphomas of the B-cell subtype for many years,” Dr. Adrienne Phillips, a medical oncologist at Weil Cornell Medicine, tells SurvivorNet. “The drugs in R-CHOP work in combination. It’s hard to isolate the function of any one medication because they haven’t been studied as single agents in B-cell lymphoma.”
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Studies consistently show that R-CHOP is the best combination for aggressive B-cell lymphomas. This group of drugs work together to gain an advantage over this cancer.
“For whatever reason, the lymphoma cells that should have been programmed to die are not dying. So, the R-CHOP combination works together to encourage cells to undergo what’s called apoptosis, or programmed cell death,” Dr. Phillips says.
Here’s how the acronym breaks down:
- R: Rituximab (Rituxan) is a monoclonal antibody that attaches to a specific protein called CD20, which sits on the surface of B cells. It targets the cancerous cells and destroys them.
- C: Cyclophosphamide is a chemotherapy drug.
- D: Doxorubicin is a chemotherapy drug.
- V: Vincristine is a chemotherapy drug.
- P: Prednisone is a steroid medication that brings down inflammation in the body.
“R-CHOP is primarily administered through an intravenous catheter,” Dr. Phillips says. “Rituximab and three of the medicines, the C, H, and O, are delivered through an IV. The P stands for prednisone, and that can be given in either IV or pill form.”
In most cases, doctors deliver this regimen in cycles spaced three weeks apart to help minimize toxicities and allow patients time to recover between treatment cycles. To avoid getting stuck with needles every few weeks, some patients choose to have doctors place a port in their veins. Doctors insert a flexible tube, or port, into a vein in the chest. With the port in place, health care professionals can more seamlessly deliver intravenous medication, take blood samples, and administer fluids.
Using Immunotherapy and Targeted Treatments for Non-Hodgkin Lymphoma
Rituximab (Rituxan) was the very first immunotherapy drug approved to treat some forms of non-Hodgkin lymphoma. It’s “Rituximab is the immunotherapy that has been approved the longest and we have the most experience with for lymphoma,” Dr. Elise Chong, medical oncologist at Penn Medicine, tells SurvivorNet.
The immunotherapy drug works by seeking out and sticking to another type of protein called an antigen on the surface of infection-fighting white blood cells, called B cells. The antigen in this case is CD20. Rituxan will only work on cancerous B cells with the CD20 antigen on their surface. Most T-cell lymphomas don’t contain this protein, which is why this treatment isn’t effective against them.
Rituxan can be prescribed as the very first treatment for non-Hodgkin lymphoma, or after you’ve already been on chemotherapy. Your doctor can prescribe this drug on its own (which is called monotherapy), or together with chemotherapy (which doctors call chemoimmunotherapy).
Rituxan does come with side effects which may include fever, chills, swelling under the skin, itching, and mild shortness of breath.
WATCH: How Adcetris helps treat Hodgkin lymphoma and non-Hodgkin lymphoma.
Brentuximab vedotin (Adcetris) is a relatively new targeted treatment for non-Hodgkin lymphoma and Hodgkin lymphoma. This drug is an antibody-drug conjugate that combines an antibody (a type of protein that recognizes foreign substances in the body) with a drug that treats cancer. It uses a special protein to deliver medicine directly into the cancer cell.
When it locks onto that protein, “It has a bit of poison that it injects into the cancer cell to kill the cell,” Dr. Sairah Ahmed, associate professor in the Department of Lymphoma/Myeloma, Division of Cancer Medicine at MD Anderson Cancer Center, tells SurvivorNet.
The main side effects are low levels of certain blood cells, including the white blood cells that help your body fight infections. Your doctor can prescribe growth factors to stimulate your body’s white blood cell production and protect you against infections while you’re on this treatment.
Treating non-Hodgkin Lymphoma with Radiation
Non-Hodgkin lymphoma can also be treated with radiation which aims beams of intense energy at the cancer to stop cancer cells from growing and dividing.
One area where radiation is especially effective is in consolidation therapy. This is when you get radiation after other treatments, to try to get rid of any cancer cells that might still remain in your body.
Radiation works particularly well in people with early-stage non-Hodgkin lymphoma. “For patients with stage I and stage II disease, the outcomes are excellent, approaching 90%,” Dr. Chelsea Pinnix, radiation oncologist at MD Anderson Cancer Center, tells SurvivorNet.
Although radiation therapy is quite helpful for treating non-Hodgkin lymphoma, it does come with side effects. The side effects may include red or blistered skin, mouth sores, nausea, and vomiting.
Contributing: SurvivorNet Staff
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