Dr. Jennifer Crombie Dana-Farber Cancer Institute

About 60%of people with non-Hodgkin lymphoma, and specifically people with the most common subtype, diffuse large B-cell lymphoma, who go on the combination drug treatment R-CHOPwill be cured. Yet that still means about 40% of people will finish this treatment, only to discover that they still have to worry about their cancer.

Fortunately, the bounty of new treatments that have come out in recent years have given hope to people who didnt respond the first time around. Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Center, says she has good news for worried patients. If they fall into that subgroup of patients who dont have the response that were hoping for, or if their disease comes back after an initial remission, we do have other treatments, she tells SurvivorNet.

The typical next step if your cancer comes back or doesnt respond to R-CHOP is to get a different kind of chemotherapy than you had the first time. This is often called salvage chemotherapy. Each chemotherapy drug works a little bit differently for every person, and its possible that a new medicine will be more effective against your cancer.

Doctors follow up that second round of chemo with a stem cell transplant. These are patients own stem cells that we take from them and then give them back after additional chemotherapy, Dr. Crombie says.

Stem cells are the immature blood cells in your bone marrow. Some of them grow into the white blood cells that help your body fight infections. In non-Hodgkin lymphoma, those cells are abnormal. A transplant replaces the abnormal stem cells with healthy ones.

First, youll get high doses of chemotherapy to get rid of the damaged white blood cells. Then you get new, healthy stem cells either from yourself or a donor to repopulate your bone marrow. After a couple of weeks, the stem cells will start to make healthy new blood cells.

Because chemotherapy is part of the stem cell transplant, this treatment works best if your cancer is sensitive to chemotherapy. So you probably wont get a stem cell transplant unless your cancer is still sensitive to chemotherapy, Dr. Crombie says. But if you are responsive to chemotherapy, adding the stem cell transplant could put you into a lasting remission, or even cure your lymphoma.

What happens if a stem cell transplant doesnt keep your cancer at bay, or your cancer isnt sensitive to the salvage chemotherapy?

If the stem cell transplant doesnt put you into remission, your cancer comes back afterward, or your cancer doesnt respond to salvage chemotherapy, there is a new treatment that Dr. Crombie refers to as a breakthrough. Its called chimeric antigen receptor (CAR) T-cell therapy.

That is a novel therapy where a patients own immune cells, called T-cells, can be taken from the body and engineered in the lab, she says. Its sometimes referred to as a living therapy, because it uses actual living cells.

T-cells are the immune cells that help your body fight off germs. During this treatment, your doctor first separates out the T-cells from a sample of your blood. Those cells are then altered in a lab to make them produce special proteins chimeric antigen receptors on their surface. Then theyre multiplied, and millions of these cells go back into your body. Once there, the new fighter T-cells attach to a protein on the surface of cancer cells, and attack the cancer.

CAR T-cell therapy is also an exciting option for patients who havent been able to respond to chemotherapy before, or have had their disease come back despite prior therapy, Dr. Crombie says.

Now, researchers are investigating whether giving patients CAR-T cells earlier in treatment might keep their cancer away better than chemotherapy and stem cell transplant. The answer to that question is still unknown. Well have to await the data to see which is the better second choice in the future, Dr. Crombie tells SurvivorNet. Researchers are also studying the effectiveness of CAR-T cell therapy in other types of less aggressive non-Hodgkin lymphoma.

Learn more about SurvivorNet's rigorous medical review process.

Dr. Jennifer Crombie is a medical oncologist at Dana-Farber Cancer Institute in Boston, Massachusetts. She is also aninstructor in medicine at Harvard Medical School. Read More

Dr. Jennifer Crombie Dana-Farber Cancer Institute

Fortunately, the bounty of new treatments that have come out in recent years have given hope to people who didnt respond the first time around. Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Center, says she has good news for worried patients. If they fall into that subgroup of patients who dont have the response that were hoping for, or if their disease comes back after an initial remission, we do have other treatments, she tells SurvivorNet.

Doctors follow up that second round of chemo with a stem cell transplant. These are patients own stem cells that we take from them and then give them back after additional chemotherapy, Dr. Crombie says.

Stem cells are the immature blood cells in your bone marrow. Some of them grow into the white blood cells that help your body fight infections. In non-Hodgkin lymphoma, those cells are abnormal. A transplant replaces the abnormal stem cells with healthy ones.

First, youll get high doses of chemotherapy to get rid of the damaged white blood cells. Then you get new, healthy stem cells either from yourself or a donor to repopulate your bone marrow. After a couple of weeks, the stem cells will start to make healthy new blood cells.

Because chemotherapy is part of the stem cell transplant, this treatment works best if your cancer is sensitive to chemotherapy. So you probably wont get a stem cell transplant unless your cancer is still sensitive to chemotherapy, Dr. Crombie says. But if you are responsive to chemotherapy, adding the stem cell transplant could put you into a lasting remission, or even cure your lymphoma.

What happens if a stem cell transplant doesnt keep your cancer at bay, or your cancer isnt sensitive to the salvage chemotherapy?

If the stem cell transplant doesnt put you into remission, your cancer comes back afterward, or your cancer doesnt respond to salvage chemotherapy, there is a new treatment that Dr. Crombie refers to as a breakthrough. Its called chimeric antigen receptor (CAR) T-cell therapy.

That is a novel therapy where a patients own immune cells, called T-cells, can be taken from the body and engineered in the lab, she says. Its sometimes referred to as a living therapy, because it uses actual living cells.

T-cells are the immune cells that help your body fight off germs. During this treatment, your doctor first separates out the T-cells from a sample of your blood. Those cells are then altered in a lab to make them produce special proteins chimeric antigen receptors on their surface. Then theyre multiplied, and millions of these cells go back into your body. Once there, the new fighter T-cells attach to a protein on the surface of cancer cells, and attack the cancer.

CAR T-cell therapy is also an exciting option for patients who havent been able to respond to chemotherapy before, or have had their disease come back despite prior therapy, Dr. Crombie says.

Now, researchers are investigating whether giving patients CAR-T cells earlier in treatment might keep their cancer away better than chemotherapy and stem cell transplant. The answer to that question is still unknown. Well have to await the data to see which is the better second choice in the future, Dr. Crombie tells SurvivorNet. Researchers are also studying the effectiveness of CAR-T cell therapy in other types of less aggressive non-Hodgkin lymphoma.

Learn more about SurvivorNet's rigorous medical review process.

Dr. Jennifer Crombie is a medical oncologist at Dana-Farber Cancer Institute in Boston, Massachusetts. She is also aninstructor in medicine at Harvard Medical School. Read More

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Next Steps: What to Do When the First Non-Hodgkin Lymphoma Treatment You Try Doesnt Work - SurvivorNet