Mikayla Weaver should be worrying about what dress she’ll wear to prom. But, instead, the 17-year-old is battling stage 3
, a cancer of the immune system.
Weaver’s cancer journey began during a quarantine for a COVID-19 infection when it started to hurt to breathe. After a trip to the hospital, doctors discovered cancer spots on the left side of her chest during a scan.
The term diffuse large B-cell lymphoma is used to describe a group of fast-growing B-cell non-Hodgkin lymphomas (NHL) in which the cancer cells look large when viewed under a microscope. Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma, and it is marked by rapidly growing tumors in the lymph nodes, spleen, liver, bone marrow, or other tissues and organs. Symptoms of this kind of lymphoma may include swollen lymph nodes, fever, drenching night sweats, fatigue, and weight loss.
Weaver’s doctors are optimistic about her treatment path ahead, but that doesn’t mean it won’t be tough. She recently had her first chemotherapy treatment, but an upcoming appointment will decide if her chemo will increase.
Regardless, the young girl is doing everything she can to stay positive. Therapy is helping her practice redirecting her thoughts when she starts feeling down.
“If you start to let it get to you, just think about something else. Think of something that makes you happy,” she explained of her therapist’s advice.
Determined to go to her senior prom and walk across the stage for graduation, Weaver has also been making an effort to plan out these events with her doctors and social worker.
“She’s come so far and worked so hard,” her mother, Samantha Beasley, said. “This cancer is not taking that from her.”
And her future plans don’t stop there. Her hard work and love for fixing cars got her accepted to her dream college in Tennessee. She’s planning on attending Lincoln Tech for Collision Repair and Refinishing Technology later this year.
In support of Weaver and her family, a friend has set up a GoFundMe page to “help with everyday needs, medical bills, transportation and anything other expenses that are out of pocket.”
Lymphoma Treatment Options
Lymphoma treatment, in general, varies depending on the nature of each specific diagnosis. For non-Hodgkin lymphoma patients like Mikayla Weaver, their lymphoma is more likely to spread randomly and be found in different groups of lymph nodes in the body. Conversely, Hodgkin lymphomas are more likely to grow uniformly from one group of lymph nodes directly to another.
And even if you’re not diagnosed with lymphoma until a later stage, it’s important to know that there are still great options.
“Unlike other cancers, where advanced stage is a death sentence, that’s certainly not the case for lymphoma,” Dr. Elise Chong, a medical oncologist at Penn Medicine, told SurvivorNet. “We have many treatments with which people can either be cured with advanced stage lymphoma or have very good remissions.
“So, it doesn’t change how treatable someone is, even when they do have advanced stage lymphoma.”
And indolent lymphomas might not even require immediate treatment because of their slow-growing nature. Instead, careful monitoring – which includes imaging scans such as PET/CT – is used to track the progress of the disease and gauge whether treatment is needed.
“Where I use PET/CT in my practice quite a bit is if I’m observing a patient … and there is some new symptom or situation which makes me concerned that the patient may be changing from an indolent lymphoma to a more aggressive lymphoma,” Dr. Jakub Svoboda, a medical oncologist at Penn Medicine, previously told SurvivorNet. “We refer to it as transformation.”
Advances in Treatment
Thankfully, the lymphoma treatment landscape is also seeing advancements. According to the National Cancer Institute, most research on treatment for non-Hodgkin lymphoma is now focused on targeted therapy and immunotherapy, and researchers are also trying to identify gene changes in different types of lymphoma that might be targets for new drug development.
One exciting development from last year was the U.S. Food and Drug Administration approval of Yescarta (axicabtagene ciloleucel) as an immunotherapy treatment for certain adult patients with large B-cell lymphoma (LBCL) that comes back.
CAR T-cell therapy stands for chimeric antigen receptor T-cell therapy. Generally speaking, it is a way to get immune cells called T cells (a type of white blood cell) to fight cancer by changing them in the lab so they can find and destroy cancer cells.
Yescarta had previously been approved for LBCL patients who’ve had their second relapse, but the April 2022 approval meant that adult patients with large B-cell lymphoma that is refractory (stopped responding) to first-line chemo-immunotherapy or relapsed (came back) within 12 months of first-line chemo-immunotherapy could use the treatment. First-line therapy is the first treatment given for a disease.
Dr. Alison Sehgal, a study investigator for the landmark clinical trial that the approval was based on, previously spoke with SurvivorNet about the impact of the drug approval.
“(The current standard of care) doesn’t work very well in that population, and that population is a pretty big group of people, unfortunately,” Dr. Alison Sehgal, a hematologist and medical oncologist at UPMC Hillman Cancer Center, said. “This is really practice-changing for a big portion of people with large B-cell lymphoma.”
In addition, researchers are also looking into the use of Imbruvica (ibrutinib) for lymphoma patients in a number of different ways. This drug was designed to shut down the B-cell receptor signaling pathway that drives many types of non-Hodgkin lymphoma.
An important study showed that Imbruvica has some effectiveness in fighting a type of non-Hodgkin lymphoma called mantle cell lymphoma (MCL), but it hasn’t increased the overall survival rate for these patients so far.
According to data from the randomized, phase 3 SHINE trial, the use of Imbruvica in combination with the standard of care regimen can improve progression-free survival, or PFS, by 2.3 years among newly diagnosed patients with MCL. PFS is defined as the length of time from random assignment to disease progression or death. It’s also worth noting there was higher toxicity with the three drug regimen that included Imbruvica.
“It is still too soon to say if this regimen will lead to a new standard of care for older patients with mantle cell lymphoma,” Dr. Bijal Shah, a medical oncologist in Moffitt Cancer Center’s Malignant Hematology Department, previously told SurvivorNet. “I think a major challenge with the data presented relates to the need and benefit versus the toxicity of adding bendamustine.
“Notably, overall survival was not improved, and it suggests that a safe alternative is to deliver ibrutinib-based therapy at the time of relapse. It is hoped with future BTKi trials, we will learn more about the importance, or lack thereof, of the bendamustine component.”
As of right now, the drug has been approved for the treatment of small lymphocytic lymphoma and Waldenstrom macroglobulinemia – both of which indolent non-Hodgkin lymphomas. It has also received approval for mantle cell lymphoma (which can be aggressive or indolent) and marginal zone lymphoma (indolent).
There are also plenty of other treatments being studied. If you or a loved one has been diagnosed with lymphoma, make sure you talk about all your options with your doctors. And don’t be afraid to get second and third opinions. You have every right to know what treatment options are out there and feel confident that you’ve chosen the most appropriate one for you.
Contributing: Laura Gesualdi-Gilmore, Dr. Sufana Shikdar