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John's story begins in December 2018 with a diagnosis of Non-Hodgkin Lymphoma-Diffuse Large B Cell. Within just 2 weeks of his diagnosis, he received his first chemo treatment called R-CHOP. John had six rounds of R-CHOP and three rounds of high dose chemo at Riverside Hospital and when he was just half way through this first line treatment, a routine CT scan showed promising results- the tumors were shrinking! However, after he completing his treatments, June 2019 CT and PET scans showed that while most of the tumors were gone, two remained in his liver. This is called refractory or a partial response to the R-CHOP.
While this was disappointing news, John was set to move forward with standard second line treatment which is a Stem Cell transplant at the James Cancer Hospital. In order to receive a Stem Cell transplant, John would need two more rounds of a chemo called RICE in the hopes that he would go into a remission for a transplant to be successful. After two rounds of RICE the scans showed that the tumors in his liver remained and that a Stem Cell transplant would not be possible.
Again, John had to move on. Standard third line treatment is CAR-T, a promising type of immuno-therapy. This treatment took place at the James at the end of November 2019 and takes time to show results. At the James, the doctors checked John's labs once a week to monitor certain levels and repeated scans after 60 days from the infusion in November. On January 30, 2020, the scans showed that the treatment was not successful and that the cancer had spread.
This news was devastating. Such high hopes were riding on the CAR-T to work! John's doctor was disappointed with this set back and the aggressiveness of the cancer, but told him not to give up! He admitted John to the James that very evening and started him on steroids and fluids while a new treatment plan could be put in place. Because the cancer had spread, he also needed a stent placed in one of the bile ducts in his liver. The liver seems to be where the cancer is most persistent and this also determined the doctors decision to start him on a treatment of lenalidomide since it is metabolized in the kidneys. Many treatments or clinical trials that the doctors would like to try are metabolized through the liver and this is not an option until John's liver functions improve.
John has just completed one round of lenalidomide and has one more to go until he has scans once again to show how successful this treatment is at shrinking the tumors or at least preventing the cancer from progressing further. While this has been a long and difficult journey, John and family are trying to "forget the rain, and look for the rainbows" !