Diffuse Large B-Cell Lymphoma (DLBCL) is the most common type of lymph cancer that is not Hodgkin lymphoma. Although the disease was previously considered aggressive with a grim prognosis, many innovations in treatment bring new hope to patients. Dr. Erel Joffe, director of the clinical research unit in the hematology system in Ichilov, sheds light on the exciting developments in the field.
First, what is DLBCL?
DLBCL accounts for about 40% of all lymphoma cancers in adults, and appears on average at the age of 64. In the past, about half of the patients did not survive beyond 5 years from diagnosis. However, Dr. Joffe emphasizes that these old statistics do not reflect the current reality: "You have to be careful with Google statistics because it is very stressful. Today, in lymphomas in general and in DLBCL like all other lymphomas, by and large there is some kind of rule of 70-30, 80-20".
The response to treatment
Dr. Joffe explains that 70%-80% of patients respond well to chemotherapy: "Those 70-80% suffer from a disease that is very sensitive to chemotherapy. In other words, she responds amazingly to chemotherapy."
For these patients, the treatment can lead to a complete cure or long-term remissions, allowing a life expectancy similar to the general population.
The challenge: 20-30% who do not respond to standard treatment
The main challenge remains for the 20-30% of patients who do not respond to chemotherapy. However, in recent years there has been a revolution in treatment: "In the last 5-10 years there is a sudden revolution in which new drugs appear. Biological drugs, immunotherapy drugs, molecular drugs that change the face of treatment," explains Dr. Joffe.
The innovative treatments
Dr. Joffe describes a number Innovative approaches:
Antibodies signal: "In the first step they developed antibodies, which are proteins that bind to the cells and suddenly the immune system sees the cells and can attack them."
Immunotherapy: Drugs that activate the immune system, "making it more alive and aggressive".
Genetic engineering of the cells of the immune system: "We take the cells of the immune system from the patient and in the laboratory we genetically engineer the cell to recognize the cancer cell and be activated."
Bi-functional antibodies: "We will build antibodies, but instead of them just marking the cancer cell, we will give the antibody one arm that will catch on the immune system, activate the cells of the immune system, a second arm that will catch on the lymphoma or the cancer, and we will attach them."
Targeted chemotherapy: "Medications have been developed that contain some chemotherapy that is injected directly into the cell. So it reaches very, very high concentrations in the cell but without causing side effects."
Current and future challenges
Dr. Joffe points out two main challenges: "Finding the best treatment for the seriously ill with minimal side effects and reducing toxicity and reducing treatments for patients who respond well to chemotherapy."
A look to the future
At the last EHA conference, which took place in June, clinical studies were presented about a new group of treatments based on a bi-specific antibody, which proved effective in the third line. These antibodies bind on the one hand to the T-Cell immune system cells and on the other hand to the B-Cell lymphoma cells and cause the T cells to act and cause the destruction of the cancerous B cells.
Dr. Joffe is optimistic about the future: "In my opinion, DLBCL is a curable disease. We will approach 95 percent healing. That means people will come, receive one treatment, maybe two types of treatments and that's it." He emphasizes that "cure" means that the disease passes and does not return, and the patient returns to normal life with an expected life expectancy almost identical to that of a person who has never been sick.
It seems that the revolution DLBCL treatment brings new hope to patients With the advancement of research and innovative treatments, the expectation is that in the near future, the vast majority of patients will be able to expect a full recovery and return to a full and healthy life.