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Lalitha Kumari, a 47-year-old math teacher from Bobbili, Andhra Pradesh had hardly taken a day off from work during her two decades of teaching career. She was known for being a fit person until one day in June 2022, when she was diagnosed with Refractory Diffuse Large B-cell Lymphoma (DLBCL), a form of aggressive lymphoma (blood) cancer that rapidly spreads throughout the body. Adding to the worry, the lymphoma was resistant to conventional cancer treatment because it was so aggressive. With an innovative approach to arrest refractory cancer in February 2024, Lalitha received CAR-T cell therapy for lymphoma, making her the first person in Andhra Pradesh to receive it, claims Apollo Cancer Centre, Vishakhapatnam where she was treated.
What is DLBCL?
Refractory Diffuse Large B-cell Lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma that affects a type of white blood cell called the B-cell. These cancerous B-cells tend to multiply in the system causing tumors in the lymph nodes or areas outside the lymph nodes like bone, brain, breast etc.
Lalitha noticed that she had developed lumps on her neck due to which she had to undergo a biopsy, after which she was diagnosed with 4th stage DLBCL. “To arrest the rapid growth of these cancer cells, the options available were chemotherapy and bone marrow transplant,” says Dr Atchyuth R Gongada, Lalitha’s relative, who is also an intensive care specialist.
Relapse post chemotherapy and bone marrow transplant
Until October 2022, Lalitha went under chemotherapy for DLBCL. The initial response to the therapy was satisfactory, however, the cancer relapsed in July 2023, within nine months from the last cycle of her chemotherapy. “Since the DLBCL cells were aggressive, chemotherapy for this type of lymphoma is only 60% effective, with a 40% chance of relapse,” says Dr Rakesh Reddy Boya, senior consultant – Medical & Hemato Oncology, Apollo Cancer Centre, Vishakapatanam, who treated Lalitha. He mentions that she had to undergo three cycles of R-ICE chemotherapy (a treatment for a type of lymphoma that uses multiple drugs to kill the cancer cells) in July 2023 but again relapsed within three months.
However, not being one to give up, she agreed to the second line of treatment in October 2023 – an autologous bone marrow transplant (BMT), wherein the person’s bone marrow is collected, stored, and returned to the body after intense chemotherapy. “The cancerous lymphoma cells were removed from her bone marrow, and new cells were grafted, which were expected to proliferate,” says Dr Gongada. “However, a small portion of the DLBCL cells remained alive, which exponentially grew, resulting in her relapse of cancer within 2-4 months,” he says.
It was a devastating scenario for Lalitha and her family to witness both chemotherapy and BMT failing to help her bail out of cancer. In December 2023, her health started to deteriorate exponentially. But her will to fight against the disease and her dream to see their twin daughters settle down in their lives, motivated Lalitha to undergo CAR-T Cell Therapy for lymphoma.
CAR-T Cell Therapy for DLBCL
Lalitha’s case required a different approach due to the refractory nature of the disease and CAR-T Cell Therapy emerged as a viable option. Considered as a type of gene therapy, in CAR-T cell therapy, the infected person’s immune cells are re-engineered to arrest the cancer cells. Dr Boya explains the different phases during the treatment. “The first trial of treatment took place in the first week of February 2024, when we took her T-cells (type of immune cells) from her blood and sent it to the lab,” explains Dr Boya. “Later the cells were genetically engineered and modified to become CAR-T cells and were infused into her system during multiple settings from February and early March. “The treatment went smoothly even though we anticipated a lot of side effects,” explains Dr Boya. Since the medical team took preventive interventions to deal with the side effects, she tolerated it better.
Remission and getting back to work
Following the CAR-T Cell therapy for lymphoma, Lalitha’s cancer led to complete remission for the last month with no cancer cells being traced in the PET scan. “The most incredible news was hearing from the doctors – I am cancer-free. Being a Math teacher, I always believe that every problem has a solution and, in my case,I got the right treatment with CAR-T cell therapy,” says Lalitha.
When asked if she could resume her normal routine, Dr Boya mentioned that she could, however, would still be required to take preventive measures. “She is still at a higher risk of infection, so we have advised her to return to work after a few more PET scans in two months,” he says.
Dr Gongada mentions that she is happy to be alive regardless of certain restrictions. “Her diet for now has been prescribed by a dietician, to prevent infections that can be transmitted by food. She cannot venture out and would have to remain home for a few more months, but you can see her smile and feel elated regardless of her situation,” he adds.
Takeaways
- Refractory Diffuse Large B-cell Lymphoma (DLBCL) is an aggressive form of non-Hodgkin lymphoma that can be resistant to conventional therapies.
- DLBCL multiplies in the body causing tumors in the lymph nodes or areas outside the lymph nodes like bone, brain, breast etc.
- In CAR-T cell therapy, the infected person’s immune cells are re-engineered to arrest the cancer cells and the therapy has been found promising.
