Clinicians at the Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital are experts in treating all stages and types of lymphoma, including relapsed and refractory lymphoma, with access to proton therapy, immunotherapies and novel treatments via clinical trials. For more complex cases, a panel of multidisciplinary experts from throughout the Johns Hopkins system helps determine the best path of care, which is delivered in Washington, D.C.
“Because lymphomas are complicated — biologically, pathologically and clinically,” says Kimmel Cancer Center medical oncologist Khaled El-Shami, “patients are best served in a large-volume center with extensive experience in diagnosis, subtyping, molecular interrogation of lymphoma cells, risk stratification and treatment.”
Lymphoma Treatments at Sibley: Immunotherapies, Proton Radiation and Cutting-Edge Clinical Trials
While lymphomas are primarily treated with systemic therapy, with radiation often playing an adjunct role, at the Kimmel Cancer Center at Sibley, genetic interrogation of the patients’ lymphoma cells provides the opportunity for precision medicine, targeted therapies and risk-adapted approaches to treatment. These approaches include proton radiation; targeted therapies; immunotherapies, such as CAR-T cell therapy; and a number of treatments via clinical trials, including stem cell transplantation, for those patients for whom this type of treatment provides a potentially curative option for an otherwise incurable disease.
Immunotherapy through checkpoint inhibitors can help treat relapsed Hodgkin lymphoma with remarkable success, says El-Shami, an assistant professor of oncology in the Division of Hematologic Malignancies at the Johns Hopkins University School of Medicine. These approaches are also being increasingly used in non-Hodgkin lymphoma. CAR-T cell therapy, for example, involves genetically modifying a patient’s own T cells to recognize a specific target on B-cell lymphocytes and then reinfusing the T cells into the patient.
“The use of CAR-T cell therapy has changed the outlook and outcomes of patients with multiple relapsed or refractory B-cell non-Hodgkin lymphomas in an impressive way,” he says.
For patients who need radiation, the Johns Hopkins Proton Therapy Center, located at Sibley, boasts the most advanced proton therapy system, which deposits nearly all the radiation directly on the tumor, sparing surrounding organs and critical structures. Proton therapy can be useful for patients who previously had radiation, as well as patients with lymphoma near the spine, head, neck and base of the skull.
For patients with relapsed or refractory lymphoma, Sibley, as well as the larger Johns Hopkins system, has a number of clinical trials offering novel treatments or novel combinations of individually active therapies. Among these are stem cell transplants. Johns Hopkins performs more than 300 of these procedures each year, with outcomes among the best in the nation and world, El-Shami says.
When to Refer a Patient
El-Shami encourages physicians to maintain a high level of suspicion due to lymphoma’s common occurrence: More than 80,000 people are diagnosed each year. About two-thirds of patients will present with enlarged lymph nodes. Other patients present with unexplained fevers, drenching night sweats and unintentional weight loss. Since lymphoma can involve any organ in the body, it can present in the brain with neurologic deficits, in the bone marrow with bone marrow failure or in the stomach with gastrointestinal symptoms. If you have a patient who is experiencing these symptoms or if you would like to discuss a case, please call 202-660-6500 and select option 1.
For Complex Cases
Patients referred to the Kimmel Cancer Center at Sibley with difficult and challenging presentations of disease can have their cases evaluated by a panel of experts from throughout the Johns Hopkins system. In weekly meetings, hematopathologists, radiology experts, lymphoma medical oncologists and radiation oncologists discuss the nuances of complicated lymphoma cases and help determine treatment paths.
“This critical mass of brains is a huge benefit to patients with particularly complicated diseases where multiple experts look from different angles at the diseases and discuss any additional diagnostic or prognostic workup as well as the best possible therapeutic approaches,” El-Shami says.