Blood Cancer Awareness Month: Advances in Lymphoma

In recognition of September as Blood Cancer Awareness Month, Andrew Jallouk, MD, assistant professor of medicine at Vanderbilt University, discusses the surge of approved therapies in lymphoma over the past decade.

Before the mid-2010s, the primary treatments were largely limited to chemotherapy and rituximab (Rituxan), a monoclonal antibody that targets the CD20 protein on B-cells. While rituximab was a monumental breakthrough and a great advance, for a long time, it was one of the few options available. These treatments could cure a subset of lymphomas, but a relapse often meant a drastically reduced chance of a cure.

The landscape of lymphoma treatment has since been transformed by the introduction of several novel therapies that fall into different categories, providing more targeted and effective options for patients. These new treatments have emerged in just the last 10 years.

A key area of progress has been the development of targeted antibodies. Unlike traditional chemotherapy that affects all rapidly dividing cells, these antibodies are designed to deliver chemotherapy agents directly to specific cell types, minimizing damage to healthy tissue and reducing side effects. We also have bispecific antibodies, which are a type of immunotherapy. They can bind to two different targets simultaneously, often a T cell and a cancer cell, bringing them into close proximity to facilitate the T cell's attack on the cancer cell.

Another class of targeted therapies are BTK inhibitors, which block a signaling pathway essential for the growth and survival of certain B-cell lymphomas. These oral medications have revolutionized the treatment of some chronic lymphocytic leukemias and lymphomas, offering an alternative to traditional chemotherapy.

Perhaps the most groundbreaking advancement is chimeric antigen receptor (CAR) T-cell therapy. This is a form of immunotherapy where a patient's own T cells are genetically engineered to recognize and attack their cancer cells. The process involves collecting T cells from the patient, modifying them in a lab to express a new receptor (the CAR) that specifically targets the cancer, and then reinfusing these "supercharged" T cells back into the patient. This has led to remarkable remission rates in patients with certain types of aggressive lymphoma who had exhausted all other treatment options.

The vast array of new therapies, from targeted antibodies to CAR T-cell therapies, has dramatically improved the outlook for many patients. For some diseases that previously had poor prognoses, we now have treatments that can provide patients with a high quality of life for long periods. In some cases, these new therapies are even curing conditions that would not have been curable before.

The sheer breadth of all the different therapies available now represents a huge advance in the lymphoma field. The next challenge for oncologists is to determine the best way to utilize all of these tools, figuring out which patient benefits most from which specific treatment or combination of treatments.