Lymphoma: Insidious, Increasing

February 2, 2012

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Jama Beasley of Redding, Calif., was busy running a business in the early 1990s when she started feeling ill. The 45-year-old was tired most of the time, had a lingering, low-grade fever and suffered frequent night sweats. Menopause, her local doctors kept telling her, and they gave her hormone therapy. But the symptoms persisted. After seeing six physicians in one year, she was finally referred to a psychiatrist.

It took an mri scan for a separate back ailment to reveal what the other symptoms meant. The scan showed a mass the size of a volleyball in her abdomen, which doctors at Stanford later diagnosed as B-cell lymphoma. "The tumor was so big it was like a child in there," recalls Beasley, who has been disease-free in the six years since she received chemotherapy followed by Levy's vaccine.

B-cell lymphoma is Levy's nemesis, the incurable cancer to which he has devoted his career. It's the most common of the malignancies known as non-Hodgkin's lymphomas, which together represent the nation's sixth leading cancer diagnosis. While some other cancers have declined in recent decades, non-Hodgkin's lymphomas have mysteriously increased, with new cases rising by 75 percent over the past 20 years, according to the National Cancer Institute. (Pesticide exposure is among the suspects; one sure factor is aids.) Approximately 250,000 Americans currently have this disease, and some 62,000 new cases turn up each year.

All lymphomas are cancers of the lymphatic system--the network of tissues, organs and vessels that sends infection-fighting white blood cells coursing through the body. The malignancies can arise practically anywhere in the body, eventually filling lymph nodes with proliferating cells that become firm tumors. Often, patients don't feel any tumors. Instead, like Beasley, they experience general malaise, including exhaustion, low fever and persistent night sweats.

So far, researchers have delineated about 35 types of non-Hodgkin's lymphomas. These are categorized by the rate of cell proliferation, the developmental stage at which the cells first went haywire, and the kind of cell involved (B versus T lymphocytes). When white cells turn malignant at a very early stage, they can become leukemia, a close relative of lymphoma.

Ironically, faster-growing, "aggressive" lymphomas respond relatively well to chemotherapy, with about 40 percent of patients experiencing remissions lasting five to 10 years. But most participants in Levy's trials have slow-growing tumors of advanced-stage B cells. With such "indolent" malignancies, the outlook is murkier. Tumors might vanish for years after chemotherapy--occasionally even for a decade--but they inevitably return at an accelerating pace. Most such patients die within 10 years of diagnosis.

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