The Treatment Method Saving Lymphoma Patients

The technological advancements in the medical world over the past few years provide developments that seem as if they are taken from science fiction films, yet they are entirely real and are already helping to treat diseases that until recently had no solution. A new treatment, added to the health basket three years ago, assists types of cancer that had no suitable treatment until recently.

Follicular lymphoma is an incurable disease. It is possible to live many years with follicular lymphoma with or without treatment, but once it poses a risk to the patient or becomes symptomatic, we must treat it.

Lymphoma is a malignant disease of the lymphocytes. The role of lymphocytes in the immune system is crucial. They travel through the blood vessels, protect against infections, and deal with foreign cells like cancer cells. Sometimes these cells, meant to treat cancer cells, become malignant themselves, which is essentially lymphoma, in a nutshell.

Lymphoma is commonly divided into two main categories: aggressive and indolent, meaning chronic and quiet. Chronic lymphomas develop slowly, with follicular lymphoma being the most common in this group. It often develops slowly, and unlike the aggressive type, one can live with it for many years, even without treatment. When it becomes symptomatic, or when detectable masses and tumors form that might endanger vital organs, treatment starts.

Follicular lymphoma becomes dangerous when damage to blood production in the bone marrow begins, hindering the body's ability to function and fend off infections. The major challenge is diagnosing the disease early because patients often feel well until it spreads. Many are diagnosed incidentally, for example, after experiencing trauma and going to the ER, or after blood tests conducted for entirely different reasons. Sometimes patients notice swelling in areas like the neck, armpits, or groins, or feel unusual abdominal pain or shortness of breath due to a tumor pressing on the airways. In later stages, fever and weight loss may also occur, often when the disease is widespread. The incidence rate of all lymphomas in the country is among the highest in the world: 16 patients per 100,000 people per year. Follicular lymphoma is the second most common, comprising about a quarter of all types. Approximately 80% of patients reach the doctor when the disease has already spread, and they are very surprised, as they did not feel it before.

When the decision is made to start treating follicular lymphoma, whether due to its aggressive nature or reaching a stage where there is no choice but to begin treatment, several options are available to the medical team and patients. First, basic treatments, which combine chemotherapy and immunotherapy, using antibodies against an antigen on lymphoma cells. This treatment is considered standard for the first line and also in cases of recurrence. The challenge begins in more advanced lines when basic treatments no longer affect the course of the disease. The introduction of CAR-T technology offers an effective solution for patients whose disease does not respond to standard treatment, with low toxicity and a tolerable side effect profile.

The innovative CAR-T cell therapy is an immunotherapy that does not rely on chemotherapy. This technology enhances the immune system's ability to combat cancer. Each of us produces cancer cells during our lives, and our immune system, mainly T cells, recognizes, attacks, and eliminates them before they can become a disease. In some people, cancer cells manage to evade the immune system, develop uninhibitedly, and become a tumor. By using CAR-T technology, the immune system is provided with tools to specifically identify and attack lymphoma cells. We essentially retrain the immune system to recognize and attack the rogue cells. We take blood from the patient and transfer it to a laboratory, where the T cells are separated from other blood components and genes are implanted to help them fight cancer cells by producing receptors against a protein on the cancer cells themselves. After this process, the renewed cells, equipped to fight lymphoma, are returned via infusion into the patient's body.

The response rates to this treatment in follicular lymphoma are particularly high, reaching about 85-90%, and in many patients, the response is maintained for a very long term. There is no doubt that treating with CAR-T cells will completely change the treatment paradigm for follicular lymphoma patients.

The author is the co-director of the Hemato-Oncology and Bone Marrow Transplantation Unit at Sheba Medical Center