Lymphoma is a type of cancer which develops from white blood cells called lymphocytes. The cancerous cells then predominately build up in lymph nodes—enlarging them to form tumors.
However, it may also develop in other parts of the lymphatic system, such as the spleen, bone marrow, blood or even other organs. The lymphatic system also includes lymphatic vessels, which provide the means for the cancerous cells to circulate throughout the body. The lymphatic system is part of the body’s immune system.
There are two main groups of lymphoma—Hodgkin (HL) and non-Hodgkin (NHL).
Differences exist among the various types of lymphomas, but all affect the cells that play a role in the body’s immune system.
Hodgkin lymphoma (HL) is the least common form of this disease. A microscopic exam of a tissue biopsy is to necessary to differentiate between Hodgkin and Non-Hodgkin lymphoma. If the abnormal cells are identified as Reed-Sternberg cells, then the diagnosis is HL, of which there are six sub-types.
Non-Hodgkin lymphoma (NHL) is the most common type of cancer affecting lymphocytes. There are many sub-types of non-Hodgkin lymphoma. These types can be divided into aggressive (fast-growing) and indolent (slow-growing) types. Each type is different, behaves differently and requires unique treatment options.
A subtype of NHL is Mantle Cell Lymphoma.
Currently medical oncologists base their treatment strategy on standard chemotherapy protocols for specific types of cancer.
For NHL patients, CHOP treatment where C =Cyclophosphamide, H = Doxorubicin Hydrochloride, O = vincristine (also called Oncovin) and P = Prednisone is the most widely used.
ABVD (Adriamycin (doxorubicin), Bleomycin, Vinblastine, Dacarbazine), is among the most common therapies for HL.
However, many other protocols are in use or being tested. These protocols, developed over years of clinical trials, assign patients to the drugs for which they have the greatest statistical probability of response.
The fact that all patients with lymphoma will have an equal likelihood of response to a drug does not mean they will respond equally. In some instances, the addition of a drug might be recommended, like etoposide for EPOCH. In other circumstances, more intense dosing may be preferred like Hyper-CVAD.
Nagourney Cancer Institute uses a functional profiling assay to determine which drugs work best for which patients. The test exposes living cancer cells obtained from the patient via biopsy to a variety of chemotherapy drugs and novel compounds.
Two weeks after I was diagnosed (with non-Hodgkin lymphoma), I took the Rational Therapeutics (now Nagourney Cancer Institute) test [EVA-PCD assay] and the results allowed the doctors to come up with a treatment regimen based on how well I would respond to various chemotherapies," George Kalogridis said. "My local oncologist used these recommendations. After my second round of chemotherapy, the cancer was gone.
— George Kalogridis
The standard protocol treatment for NHL is a combination of chemotherapies known as CHOP. But the assay, done at Rational Therapeutics (now Nagourney Cancer Institute), revealed that she was only moderately sensitive to these drugs.
Instead, based upon this test – a true functional profile of her tumor –Angie underwent a regimen of drugs known as Hyper-CVAD. Seven months after beginning treatment, Angie was back at work with a complete remission.
The testing by Rational Therapeutics (now Nagourney Cancer Institute) found a particular drug combination that I was especially sensitive to that also had less toxicity to my system.
Their EVA-PCD functional profiling test also showed I had some resistance to one of the drugs my two oncologists were proposing I use. There was much discussion to bring my doctors to the point where they were "comfortable" going with the recommendations of a distant doctor on the other side of the country who has never even met me!
I personally felt it was a God-intervention that led me to even know about Rational Therapeutics at the exact time I needed it!
— Angela Garvin
Dr. Beebee, an 80 year old pediatrician, presented to Dr. Nagourney's office with extensive lymphadenopathy. Lymph node and bone marrow biopsies established mantle cell lymphoma with over 40% marrow infiltration. The PET/CT confirmed Stage 4 Mantle Cell Lymphoma with large volume retroperitoneal disease.
Hoping to avoid excessive toxicity for an 80 year old patient, we conducted our functional profile to explore treatment options.