Understanding Risk of Relapse After Non-Hodgkin Lymphoma Treatment
- Actor Sam Neill, 76, who was diagnosed with an aggressive form of non-Hodgkin lymphoma after noticing a persistent lump in his neck two years ago, has revealed he’s not worried about an eventual relapse. Neill has been in remission for about two years.
- All non-Hodgkin lymphomas begin in white blood cells known as lymphocytes, which are part of your body’s immune system. From there, doctors separate these cancers into types depending on the specific kind of lymphocytes they grow from B cells or T cells. Knowing which one of these you have can help steer you to the most appropriate treatment for you.
- Each patient’s risk profile for relapse is different and based on multiple factors, Dr. Michael Jain, medical oncologist at the Moffitt Cancer Center, tells SurvivorNet.
Neill, an award-winning actor who starred in various movies and TV programs like “The Sullivans,” “Perfect Strangers,” and “Alcatraz,” revealed he was battling stage three blood cancer diagnosis in 2022, noting his specific disease is called angioimmunoblastic T-cell lymphoma (AITL), a rare form of non-Hodgkin lymphoma. Thankfully, the actor has been in remission for about two years.
Read MoreNeill also reportedly urged his fans not to stress over his health in a video message, saying, “I made a passing remark that the treatment I’m on, which has me in remission, will inevitably fail one day.
“It’s nothing to worry about. I’m in remission and plan to be in remission for many years to come. … At such time as it does fail, we’ll try something else.”
He concluded, “There are all sorts of things that are happening with cancer these days. It’s a whole new ball game. So please stop worrying.”
Meanwhile, in a more recent interview with The Herald Sun, Neill described his treatment plan as “a bit grim,” insisting, “Other than that, it’s great to be alive and working and in beautiful places.”
We’re happy to see Neill’s attitude remains optimistic through adversity, something others battling cancer can certainly look up to for inspiration.
Sam Neill’s Cancer Journey
Sam Neill’s cancer journey began in 2022 when he felt lumps in his neck. His doctor initially told him it was because of a COVID-19 infection, but as his symptoms persisted, he pushed for more solid answers.
“I said, these lumps don’t seem to be going down, and I don’t know why,” Neill said in his memoir “Did I Ever Tell You This.”
RELATED: Could Your Lymphoma Come Back? What Happens When You Relapse
Neill was in the middle of promoting “Jurassic World: Dominion” when his neck swelled. People magazine reported that the actor didn’t give his neck much thought until photos from the event showed that it appeared “lumpy.”
The beloved actor also talked with his doctor, who attributed the symptoms to another condition.
“He assured me that my lumpy glands were due to undetected COVID, and they’d be hanging around for a little while. I went back a week later when they were even bigger. This time, he sent me to the hospital for some tests,” Neill told People Magazine.
An eventual PET scan led to his angioimmunoblastic T-cell lymphoma (AITL) diagnosis, which is a rare and aggressive form of non-Hodgkin lymphoma.
Helping You Better Understand Lymphomas
- 6 Symptoms of Lymphoma & How to Spot Them; Radio Host Dan Bongino Recently Said He May Have This Type of Cancer
- Children with Non-Hodgkin Lymphoma Get More Aggressive Treatment, and Have Better Outcomes Than Adults
- How Effective is Radiation Treatment for Non-Hodgkin Lymphoma?
- Next Steps: What to Do When the First Non-Hodgkin Lymphoma Treatment You Try Doesn’t Work
- Age, Race, and Exposures Might All Factor Into Lymphoma Risk
- All About Biopsies to Diagnose Non-Hodgkin Lymphoma
Understanding Non-Hodgkin Lymphoma
“Non-Hodgkin lymphoma is a big category,” Dr. Julie Vose, chief of hematology/oncology at the University of Nebraska Medical Center, told SurvivorNet in an earlier interview.
All non-Hodgkin lymphomas begin in white blood cells known as lymphocytes, which are part of your body’s immune system. From there, doctors separate these cancers into types depending on the specific kind of lymphocytes they grow from B cells or T cells.
Knowing which one of these you have can help steer you to the most appropriate treatment for you.
One way doctors divide up these cancers is based on how fast they’re likely to grow and spread. “The two main classifications I think of in terms of non-Hodgkin lymphoma are lymphomas that are more indolent and those that are more aggressive because those are treated very differently,” Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Institute, tells SurvivorNet.
Most non-Hodgkin lymphomas, about 85%, affect B-cells. These cells produce antibodies and proteins that react to foreign substances like viruses or bacteria in your body. The antibodies attach to another protein on the surface of the invading cells, called an antigen, to target and destroy them.
“Within a few days, I was lying on a hospital bed having all kinds of chemicals draining into my system,” Neill said as he coped with his cancer diagnosis, an emotional moment many cancer warriors experience before they bravely battle the disease.
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Sam Neill, a father of two, started chemotherapy treatment, but once the chemo he was on stopped being effective, he switched to a different chemotherapy drug. Although he did not reveal which chemo drug he was taking, side effects such as hair loss took him aback.
“After my first chemo, it took only a little over two weeks for the hair to disappear completely from the top of my head,” Neill said.
He also lost facial hair, which revealed that his face was without his signature beard in later years, something he admitted he hadn’t seen in 15 years.
“Time has not been kind to it in the meantime. I’m not just wrinkled in the space where there formerly resided a beard; I am positively wizened. Three or four strokes of my trimmer and I had aged twenty years,” he said.
Lymphoma treatment largely depends on the nature of your specific diagnosis. For non-Hodgkin lymphoma patients, their cancer is more likely to spread randomly and be discovered in different groups of lymph nodes in the body. Hodgkin lymphoma cancers, on the other hand, are more likely to grow consistently from one group of lymph nodes directly to another.
Neill, whose chemotherapy proved successful, as the actor revealed his cancer status in an Instagram post, told his fans on March 18, 2023, “I am alive and well, and I have been in remission for eight months, which feels really good.”
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Understanding Risk of Relapse After Non-Hodgkin Lymphoma Treatment
People with lymphoma who have already undergone treatment may be optimistic about the future, while still wondering about the possibility of relapse.
Each patient’s risk profile for relapse is different and based on multiple factors, Dr. Michael Jain, medical oncologist at the Moffitt Cancer Center, tells SurvivorNet.
“For the type of lymphoma that we’re talking about diffuse large B-cell lymphoma there are a number of factors that we look at to wonder what might be a person’s risk of relapsing once they’ve had their standard upfront therapy,” he says.
Dr. Jain notes that the first treatment is typically a combination of chemotherapy, the targeted drug rituximab (Rituxan), plus the steroid prednisone, known collectively as R-CHOP.
What’s the Risk of Relapse After Non-Hodgkin Lymphoma Treatment?
“Some of these factors are clinical and have to do with the biology of the tumor,” he says. For example, there are genetic tests that may predict a high risk of relapse.
One thing these tests look for are places in the chromosome where parts of genes have swapped places. Doctors call these genetic switches “translocations,” and they often happen in the genes MYC and BCL2.
If someone has rearrangements in both the MYC and BCL2 genes, “We call these a double-hit lymphoma,” Dr. Jain explains. “And this occurs in about 5% to 10% of patients so it’s really a minority of patients.”
Though relatively rare, genetic alterations like these increase the risk of relapse. Patients with these translocations should speak with their doctors about ways to reduce the risk of having their cancer come back, he says. They often get a different initial chemotherapy treatment called dose-adjusted R-EPOCH, rather than R-CHOP.
Another factor that can increase relapse risk is age. “It turns out that the older a patient is, the higher the risk of relapse occurring,” Dr. Jain says. He notes that there are likely two reasons for this.
One reason may be that older patients have a bit more difficulty getting all of the chemotherapy and other treatments their doctor prescribed, he says. Also, “The biology of the lymphoma seems to be a bit more chemo-resistant and more aggressive the older the patients are.”
Additional risk factors include the stage of the cancer. Cancers that are at a more advanced stage tend to be more aggressive and harder to treat. Lymphomas are often at an advanced stage, Dr. Jain says. That’s because they start in immune cells, which are all over the body.
What to Do If You’re at Risk for a Relapse
Your doctor will look at these and other factors to determine your relapse risk. Overall, “We think that the risk of relapse after initial therapy … could be anywhere from 20% to maybe 50%,” Dr. Jain says. This is where vigilance is important.
The Watch & Wait Approach to Recurrence
Your oncologist will continue to monitor you for a few years after your treatment ends. During these regular follow-up visits, your doctor will give you physical exams that include an assessment of your lymph nodes, ask about your symptoms, give you blood tests to check for signs of cancer, and possibly perform imaging scans.
In between visits, let your doctor know if you have any new symptoms. If your cancer does return, catching it early will offer you the best hope of a second treatment success.
Contributing: SurvivorNet Staff
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