Using Your Cancer's Genes to Plan Treatment

When youre first diagnosed with non-Hodgkin lymphoma, your doctor will need to learn more about your tumor. Tests done on a sample of the cancer removed during a biopsy can reveal how your cancer is likely to behave whether it will grow quickly or slowly.

We do extensive molecular and genetic testing to identify certain genetic markers that can predict a high-risk behavior of the tumor, specifically gene rearrangements, Dr. Suchitra Sundaram, medical oncologist at Roswell Park Cancer Center, tells SurvivorNet.

What your doctor learns through these tests can help predict what treatments are likely to work most effectively against your cancer, and what your outcome could be.

Your biopsy sample will go to a laboratory, where a specialist called a pathologist will evaluate its size, shape, and other characteristics under a microscope including its genetic makeup. A few tests look at the cancer cells chromosomes the threads that carry the cells genetic information:

Normally, cells have 23 pairs of chromosomes. Lymphoma cells have changes in their chromosomes for example, too few or too many chromosomes, or areas where genes swap places on chromosomes. These changes can help your doctor learn what type of lymphoma you have, and how it is likely to behave.

Depending upon the number of adverse gene rearrangements identified, some of these patients can be classified into double-hit or triple-hit lymphoma, Dr. Sundaram explains.

Double-hit lymphoma is a type of lymphoma in which there are switches in two genes: MYC or BCL2. Triple-hit lymphoma has changes in three genes: MYC, BCL2, and BCL6. These genes help to control cell growth and death. Changes to them can help the cancer cells survive.

Both double- and triple-hit lymphomas are similar to diffuse large B-cell lymphoma or Burkitt lymphoma. Theyre more aggressive cancers, and people who have them typically have worse overall survival as compared to patients without these gene rearrangements, Dr. Sundaram says.

These lymphomas are more likely to start in people over age 60. They cause swollen lymph nodes, as well as whats known as B symptoms fevers, night sweats, and unexplained weight loss.

Because these cancers are so aggressive, often people are diagnosed when their cancer is already at a late stage. In a small percentage of people with double- and triple-hit lymphoma, the cancer spreads to the brain and spinal cord.

Finding gene swaps is crucial for treatment planning, because some of these patients with double-hit or triple-hit lymphoma may not have the same response to standard chemoimmunotherapy approaches compared to patients without these gene rearrangements, Dr. Sundaram tells SurvivorNet.

Double- and triple-hit lymphomas can be hard to treat. Because they are pretty rare and they havent been well-studied, there is no standard combination of chemotherapy and immunotherapy used to treat them. And, these cancers are more likely to relapse after treatment than more common types of B-cell lymphoma.

Dr. Sundaram says its important for people with double-hit and triple-hit lymphoma to enroll in clinical trials of new drugs combined with chemotherapy and immunotherapy. Taking part in one of these studies could give you access to a new treatment or combination of treatments thats not yet available to the public, and which might work better against your cancer.

Ask the doctor who treats your lymphoma if an appropriate clinical trial is available in your area. If not, your doctor may give you the standard combination of chemotherapy and the monoclonal antibody drug, rituximab (Rituxan), known as R-CHOP. Or, you could get a more intensive combination of chemotherapy and immunotherapy drugs. Your doctor might also prescribe treatment to prevent the cancer from spreading to your brain and spinal cord.

Learn more about SurvivorNet's rigorous medical review process.

Dr. Suchitra Sundaram is a medical oncologist at Roswell Park Cancer Center in Buffalo, New York, as well as an assistant professor of medicine. Her specialties include non-Hodgkin lymphoma, Hodgkin lymphoma, chronic lymphocytic leukemia, and multiple myeloma. Read More

We do extensive molecular and genetic testing to identify certain genetic markers that can predict a high-risk behavior of the tumor, specifically gene rearrangements, Dr. Suchitra Sundaram, medical oncologist at Roswell Park Cancer Center, tells SurvivorNet.

Your biopsy sample will go to a laboratory, where a specialist called a pathologist will evaluate its size, shape, and other characteristics under a microscope including its genetic makeup. A few tests look at the cancer cells chromosomes the threads that carry the cells genetic information:

Normally, cells have 23 pairs of chromosomes. Lymphoma cells have changes in their chromosomes for example, too few or too many chromosomes, or areas where genes swap places on chromosomes. These changes can help your doctor learn what type of lymphoma you have, and how it is likely to behave.

Depending upon the number of adverse gene rearrangements identified, some of these patients can be classified into double-hit or triple-hit lymphoma, Dr. Sundaram explains.

Double-hit lymphoma is a type of lymphoma in which there are switches in two genes: MYC or BCL2. Triple-hit lymphoma has changes in three genes: MYC, BCL2, and BCL6. These genes help to control cell growth and death. Changes to them can help the cancer cells survive.

Both double- and triple-hit lymphomas are similar to diffuse large B-cell lymphoma or Burkitt lymphoma. Theyre more aggressive cancers, and people who have them typically have worse overall survival as compared to patients without these gene rearrangements, Dr. Sundaram says.

These lymphomas are more likely to start in people over age 60. They cause swollen lymph nodes, as well as whats known as B symptoms fevers, night sweats, and unexplained weight loss.

Because these cancers are so aggressive, often people are diagnosed when their cancer is already at a late stage. In a small percentage of people with double- and triple-hit lymphoma, the cancer spreads to the brain and spinal cord.

Finding gene swaps is crucial for treatment planning, because some of these patients with double-hit or triple-hit lymphoma may not have the same response to standard chemoimmunotherapy approaches compared to patients without these gene rearrangements, Dr. Sundaram tells SurvivorNet.

Double- and triple-hit lymphomas can be hard to treat. Because they are pretty rare and they havent been well-studied, there is no standard combination of chemotherapy and immunotherapy used to treat them. And, these cancers are more likely to relapse after treatment than more common types of B-cell lymphoma.

Dr. Sundaram says its important for people with double-hit and triple-hit lymphoma to enroll in clinical trials of new drugs combined with chemotherapy and immunotherapy. Taking part in one of these studies could give you access to a new treatment or combination of treatments thats not yet available to the public, and which might work better against your cancer.

Ask the doctor who treats your lymphoma if an appropriate clinical trial is available in your area. If not, your doctor may give you the standard combination of chemotherapy and the monoclonal antibody drug, rituximab (Rituxan), known as R-CHOP. Or, you could get a more intensive combination of chemotherapy and immunotherapy drugs. Your doctor might also prescribe treatment to prevent the cancer from spreading to your brain and spinal cord.

Learn more about SurvivorNet's rigorous medical review process.

Dr. Suchitra Sundaram is a medical oncologist at Roswell Park Cancer Center in Buffalo, New York, as well as an assistant professor of medicine. Her specialties include non-Hodgkin lymphoma, Hodgkin lymphoma, chronic lymphocytic leukemia, and multiple myeloma. Read More

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Double-Hit and Triple-Hit Lymphoma: How Do They Affect Treatment? - SurvivorNet

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