A Perplexing Rise in Lymphoma
About two years ago, Martin Fields joined the ranks of one of the fastest-growing clubs in the United States.
Fields, the owner of a Middletown, Conn., jewelry store, was diagnosed with lymphoma, one of the most common cancers in the nation, although certainly not the most well known.
Lymphoma, a disease of the white blood cells, has been spreading at the second-fastest rate among cancers, becoming so prevalent that the Leukemia Society of America this year changed its name to the Leukemia and Lymphoma Society.
The name change reflects the fact that while about 30,000 new cases of the better-known leukemia were diagnosed in the United States last year, more than twice that number of people learned they had lymphoma.
Like other cancers, lymphoma is a cruel and disabling disease that is often deadly. But unlike its lung, colorectal, breast and prostate cancers, lymphoma has not yet yielded to the medical assaults of prevention and early detection.
During the last 25 years, the number of lymphoma diagnoses has doubled, and nobody is sure why. Scientists are looking at bacteria, viruses and exposure to toxic chemicals in the environment as possible triggers of the disease.
“Clearly, with the increase in non-Hodgkin’s lymphoma, a lot of people think something in the environment has changed,” said Dr. Arthur H. Rosenberg, director of the Bendheim Cancer Center at Greenwich Hospital in Connecticut.
This year, 62,300 cases of lymphoma will be diagnosed in the United States, and 27,500 people will die of the disease. It is the fifth-leading cause of cancer in men and women.
But the news is not all grim. Certain forms of lymphoma, especially Hodgkin’s disease, are among the most treatable cancers, with researchers testing vaccines and other immune-system therapies that look promising in early experiments.
Fields, 53, had no time to wait for a magic bullet. His diagnosis came in November 1997, after he went to the doctor complaining of night sweats, fever and swollen glands. The symptoms, classic signs of non-Hodgkin’s lymphoma, could easily be confused with the flu. But, Fields said, “I knew in my heart something was wrong.”
His intuition was right. Fields had an advanced and stubborn form of the disease known as mantle cell lymphoma.
The distinction is important because doctors have recently discovered that lymphoma is not a single disease that responds to a single therapy. In one of the latest discoveries, researchers looked at why standard chemotherapy was highly effective for some patients with a type of lymphoma called diffuse large B cell lymphoma but not for others. By mapping the genes that can be active in lymphomas, the scientists discovered that diffuse large B cell lymphoma is actually two diseases that have dramatically different molecular profiles--and thus respond differently to treatment.
Over the next few years, researchers plan to map the genes of more than 2,000 patients with many types of lymphoma to try to discover if there are many distinct varieties of the disease and to target treatments for each.
While researchers were busy in their labs, Fields was forced to try the best science can offer now. After standard chemotherapy failed, he chose to have a stem-cell transplant at Yale-New Haven Hospital. Sort of the next generation of bone-marrow transplantation, the treatment allows doctors to replace sick cells with new blood-forming cells that are supposed to help the patient produce noncancerous blood.
Often, the healthy stem cells can be harvested from the cancer patient’s own blood. But Fields was too sick to produce these cells. By a long shot, however, his sister, Harriet Fein-Deeton of Rocky Hill, Conn., turned out to be a perfect match.
On Sept. 21, 1998, Fields, who also lives in Rocky Hill, completed the grueling transplant. Before it, he endured five days of full-body radiation and two days of high-dose chemotherapy, designed to virtually destroy what remained of his immune system.
The father of five children, ranging in age from 31 to 7, said the treatment and subsequent illness and side effects from the 25 to 30 pills he still takes to stay alive are a constant challenge. But then he considers the alternative.
“Some people have cancer, and already they’re planning the funeral,” said Fields, who said he feels optimistic after 18 months in remission but realistic about his tenuous future. He said he savors every day, running the store his father founded, raising his little girl from his second marriage and talking with other people who have lymphoma.
He said he does not dwell on grim statistics.
“My goal is to inspire and help other people,” Fields said. “Because you can beat it.”
