Non-Hodgkin’s Lymphoma Awareness: Chess & Living with Cancer

No more fighting cancer. No more wars on disease, both because armed fighting (unfortunately) is a reality more or less close to our national borders, and because the war metaphor also brings with it the concept of winners and losers. And when it comes to cancer, patients and families don’t necessarily feel successful if they recover, because the long and difficult journey can have serious consequences. Nor are they among the losers if the patient succumbs in battle. From this premise comes a new information and awareness campaign focused on chess metaphorto represent the experience of those who live with the linfoma non Hodgkin and of those who study it, as one game made up of expectations, setbacks and restartswhere every choice counts. A game in which a new piece, the bridge, becomes a symbol of a closer future where scientific research paves the way for new therapeutic options, such as bispecific antibodies, capable of improving the treatment and quality of life of patients suffering from lymphoma. The initiative «Check lymphoma. A new bridge between research and treatment” is promoted by Abbvie, with the participation of AIL (Italian Association against Leukemia, Lymphoma and Myeloma), FIL (Italian Lymphoma Federation) and GFIL (Italian Group of Lymphoma Nurses). On the website www.scaccoallinfoma.it interested people can find information on lymphomas and useful materials, with video stories of patients and interviews with experts.

Non-Hodgkin’s lymphomas, indolent and aggressive

I Non-Hodgkin lymphomas include over 50 different formsand, divided into two large groups based on clinical behavior: the indolent, slow growing (about 45% of cases), with which patients can live for many years, and aggressive, fast growing but often respond well to therapies, so much so that over half of patients can recover. Among aggressive lymphomas, the diffuse large B-cell lymphoma it is the most frequent subtype, it presents with enlarged and rapidly growing lymph nodes in various locations and can also involve extralymphatic organs: approximately 150,000 are estimated new cases per year in the world and 4,400 in Italy. Among indolent lymphomas, the follicular lymphoma is the most common: the prognosis is assessed by the FLIPI index and the disease is characterized by high risk of recurrence and from one progressive resistance to conventional therapieswith reduction in progression-free survival with each new line of treatment. «These are two pathologies with different scenarios – he explains Marco Ladetto, full professor of Hematology at the University of Eastern Piedmont and director of Hematology at the Santi Antonio e Biagio and Cesare Arrigo University Hospital of Alessandria -. If we talk about relapse, we are referring to a lymphoma that, even after obtaining an optimal complete response, manifests itself again. A refractory lymphoma, on the other hand, is a condition in which a patient, despite undergoing effective therapy, does not obtain a response. In diffuse large B-cell lymphomas the recurrenceIf it occurs, it almost always appears quite early within months or a few years of remission; in follicular lymphoma, quiescent cells can survive for a long time and give rise to a relapse even after some time decades».

Diffuse large B-cell lymphoma

Although today, at the forefront, they can be obtained in diffuse large B-cell lymphoma long-lasting responses and good cure ratesthe management of patients with non-Hodgkin’s lymphoma becomes increasingly complex after each recurrence. An appropriate treatment path is essential, based on a support network that accompanies the patient from a physical, nutritional and emotional point of view and also helps him in the practical organization of treatment and checks. «Expectations for patients are profoundly changing, for many healing is possible or maintain a good quality of life despite a chronic form of lymphoma – he underlines Giuseppe Toro, AIL national president -. Lymphomas remain complex pathologies and not always easy to manage. Above all, it is not easy to accept a diagnosis of lymphoma and the impact on the quality of life of the patient, but also of the family and caregivers, is very significant. Fortunately, in recent years innovative treatments such as bispecific antibodies have arrived which also offer treatment possibilities for relapsed/refractory patients who until recently had no other treatment options available. In this scenario, AIL’s mission is to listen to patients and their families and be constantly at their side in a concrete way, first of all by supporting scientific research, then with the AIL Houses, mobility services, psychological support for the patient and caregiver, financial help and for all the bureaucratic issues that hinder the patient’s life and increase stress and suffering”.
«Currently, thanks to the advent of CAR-T cell therapies and bispecific antibodies, the prospects of patients with relapsed/refractory diffuse large B-cell lymphoma and follicular lymphoma have improved – he says Caterina Patti, director of Oncohematology at the «Villa Sofia-Cervello» combined hospitals in Palermo -. Furthermore, these innovative therapies are not only more effective, but less toxic, therefore guaranteeing an improvement in the patient’s daily life. Innovative therapies (CAR-T and bispecific antibodies) have brought with them adverse events that are very different from those expected with traditional chemotherapy and which require protected intensive monitoring. All this has led haematologists to form multidisciplinary groups involved in the management of patients and who actively participate in the well-standardised and planned diagnostic-therapeutic path.”

Invaluable help from nurses and patient groups

Right from the diagnosis, in the clinical care path of the patient with lymphoma, the figure of the caregiver and the nurse is fundamental. «The nurse, in addition to the technical role as a healthcare professional, has the role of a communicative “bridge” – remember Giuliana Nepoti, head of the GIFIL Commission – Italian Lymphoma Foundation nurses group, Hematology research nursing, Policlinico Sant’Orsola di Bologna -. Nurses are the figures to whom patients turn for questions they have not dared to ask the doctor. Our role is to transform fear into awareness, educating the patient to recognize the warning signs and normalizing the treatment process. The management is total, starting from the moment of diagnosis and ending when the patient is entrusted to follow-up.” The type of lymphoma affects not only the choice of therapy, but the patient’s quality of life and, indirectly, that of his caregiver. There are many challenges, physical and emotional, to face. «Shock at the diagnosis, anxiety, sense of isolation and loneliness, feeling of loss of normality and daily difficulties in maintaining the usual work and family rhythms – he comments Giuseppe Gioffré, national AIL representative and FIL contact person for the AIL-FIL lymphoma patient group -. In this sense, the patient group offers support to patients and their families to share fears related to relapse, and hopes, related to new treatments, helping the patient and his caregiver to adapt to changes in family dynamics and to the complex treatment path.”

How bispecific antibodies are used today

Today, thanks to research, hematologists have new treatment options available. «Recently a series of innovations have emerged in the context ofimmunotherapy – he clarifies Enrico Derenzini, associate professor of Hematology at the University of Milan and director of the Division of Oncohematology and stem cell transplantation at the European Institute of Oncology (Ieo) in Milan -. The first is represented by CAR-T cell therapies, potentially curative in approximately 40% of cases, but with a resistance problem that concerns 50%-60% of patients do not respond or relapseand long product manufacturing times, not immediately available. The other novelty is represented by the arrival of bispecific antibodieswho are redesigning the treatment of follicular lymphoma and diffuse large B-cell lymphoma, which currently in Italy they have received the indication and reimbursement after at least two previous lines of treatment. Bispecific antibodies are another form of immunotherapy, which bind on one side the T lymphocyte (CD3), the effector cells of the immune system, on the other they bind the neoplastic cells (CD20), and redirect the T lymphocytes against the lymphoma cells. Within the pivotal clinical studies, in both pathologies, this class of drugs demonstrates remissioni complete in diffuse large B-cell lymphoma in approximately 40% of cases, with significant curative potential. In follicular lymphoma, however, the complete remission rate is even higher, above 60%, and in a subpopulation of patients there is a long duration of response, with maintenance for 3 years in follicular lymphoma and over 4 years in diffuse large B-cell lymphoma. Now the indication for these drugs is as monotherapy. In the near future – concludes the expert – a rapid evolution towards an early and combined use of these treatmentsintegrating them with other drugs such as chemo-immunotherapy, immunomodulatory agents such as lenalidomide, or in association with immunoconjugated antibodies”.