Tag Archive for: infection

How Can Diffuse Large B-Cell Lymphoma Treatment Symptoms Be Managed?

How Can Diffuse Large B-Cell Lymphoma Patients Manage Treatment Symptoms? from Patient Empowerment Network on Vimeo.

How can diffuse large B-cell lymphoma (DLBCL) treatment symptoms be managed? Expert Dr. Nirav Shah from the Medical College of Wisconsin explains common symptoms and side effects that patients experience and how they can help in managing their care along with their team.

Dr. Nirav Shah is an Associate Professor at the Medical College of Wisconsin. Learn more about Dr. Shah.


“…call us. Let us know what’s going on. We can’t help you with your symptoms if we’re not aware, and we don’t mind those phone calls because we want to help patients through that journey.”


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Related Resources:

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How Is Diffuse Large B-Cell Lymphoma Explained to a Newly Diagnosed Patient?

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Is Stem Cell Transplantation Still a Treatment Option for Some DLBCL Patients


Lisa Hatfield:

So, Dr. Shah, newly diagnosed DLBCL patients, they come in and typically, you would most likely prescribe a chemotherapy regimen, and then maybe down the road they may see something like CAR-T therapy. Can you explain what type of symptoms they may or may not have, and how they can manage those symptoms and maybe even a tip on who to call when they experience symptoms? 

Dr. Nirav N. Shah:

Yeah, it’s a great question, Lisa. So the front-line regimen for diffuse large B-cell lymphoma in 2023 is a combination chemotherapy regimen. The good news is we’ve gotten so much better at delivering these drugs in a safe and efficacious manner, we’re really good at preventing those horrible things that we think about when we watch movies of people vomiting all the time and being nauseous and losing weight. We have really good antiemetics, we develop a program to deal with nausea or vomiting should it occur, and escalate our treatments to prevent it in those patients that are more sensitive to the chemotherapy drugs.

That being said, it’s still chemotherapy. And so people do feel the side effects. I think the hardest side effect for a lot of people to endure is hair loss, these combination chemotherapy do cause hair loss, and then that often is even a little bit harder for women, just given the stigma for hair and how important that is to some of our female patients, and so these are challenges that I try to discuss with patients to help them anticipate. Again, we have lots of different services at our institution, we have a wig service, a place for people to go to find options on how to deal with that.

The biggest medical symptoms that I tell people that everybody experiences is just fatigue. We’re putting poison in your body to kill a cancer. We’re doing it for a good reason, but that just wipes people out. Most patients will not have the energy, the appetite, the drive that they normally have when they’re feeling well. And again, for the most part, that’s short-lived, but for some patients that can even last three to six months after completing their chemotherapy regimen. There’s lots of individual side effects that I warn them about, the one that I am most concerned about for my patients is infection, because chemotherapy doesn’t only kill the part of the immune system, the lymphoma, it can also weaken the immune system, a part of the immune system that is there to protect you from infection.

And so we tell them to monitor for fevers, and if they’re not feeling well to call us in. We provide our patients numbers for 24/7 contact. So we have a number that they can call to, and no matter when they call, they’ll be able to get either an on-call provider or the team if it’s during the daytime, to be able to help them with whatever issue or symptoms that they’re having. And so my activation point to my patients is, call us. Let us know what’s going on. We can’t help you with your symptoms if we’re not aware, and we don’t mind those phone calls because we want to help patients through that journey. 

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Immunotherapy: Which Myeloma Patients Is It Right For?

Immunotherapy: Which Myeloma Patients Is It Right For? from Patient Empowerment Network on Vimeo.

Dr. Krina Patel, a myeloma specialist and researcher, explains how newer therapies, such as CAR T-cell therapy, are being used in myeloma and which patients these treatments are most appropriate for.

Dr. Krina Patel is an Associate Professor in the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center in Houston, Texas. Dr. Patel is involved in research and cares for patients with multiple myeloma. Learn more about Dr. Patel, here.

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How Does Immunotherapy Treat Myeloma?

What Are the Side Effects of Myeloma Immunotherapy?

Myeloma Treatment & Research Updates From 2022 ASCO and EHA Meetings



Now, in reference to immunotherapy and CAR T-cell therapy, who are these types of treatments right for?

Dr. Patel:    

So, I think it’s really exciting that we finally are getting standard of care therapies for all these new immune therapies. So, our first CAR T for myeloma got approved a little over a year ago. Our second CAR T got approved just a couple of months ago, and we’re hoping our first bispecific will be approved in just a couple months.

Our fingers crossed. On the clinical trials, I will say our patients who had a good performance status, meaning they’re able to do everything else normally life-wise, those are the patients that got onto those clinical trials; and the reason is safety-wise.

So, T cells when we use them to kill myeloma, they release cytokines or enzymes, you can say, that are inside the T cells and that’s what they use to communicate with other immune cells to come help them kill.

Those are the same cytokines that make people feel really ill when they have the flu, for instance. So, as our immune system tries to fight infections when people get fevers, they feel chills, they feel just fatigued and tired, it’s those same kind of cytokines that, even when you try to kill the myeloma with T cells, people can get that same type of symptoms.

And really, the main, fevers and things like that, we can take care of. But when patients’ blood pressure drops or if their oxygen levels drop really low, that’s where we can run into some trouble. Now, the good news is, in myeloma, most of these new therapies don’t cause really bad CRS [Cytokine Release Syndrome] or really bad neurotoxicity that we can sometimes see. And so, thankfully most patients are okay, but really it’s making sure that none of our patients have bad toxicity. So, most of our myeloma patients, I will say, are eligible for these therapies. However, if someone has really bad heart disease or really bad lung disease, those are patients that maybe these are not the right therapies for.

What Is Myeloma CAR T-Cell Therapy?

What Is Myeloma CAR T-Cell Therapy? from Patient Empowerment Network on Vimeo.

How does CAR (chimeric antigen receptor) T-cell therapy work to fight myeloma? Dr. Krina Patel, a myeloma specialist and researcher, explains how this novel therapy uses your immune system to treat the disease.

Dr. Krina Patel is an Associate Professor in the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center in Houston, Texas. Dr. Patel is involved in research and cares for patients with multiple myeloma. Learn more about Dr. Patel, here.

Related Resources:

How Does Immunotherapy Treat Myeloma?

Immunotherapy: Which Myeloma Patients Is It Right For?

Myeloma Treatment & Research Updates From 2022 ASCO and EHA Meetings



What is CAR T-cell therapy?

Dr. Patel:    

So, CAR-T cells are sort of a biologic immune therapy where we are able to take T cells, a type of lymphocyte which help us, normally. All of us have them in our blood.

They come from our bone marrow, go into our blood, and they sort of go around in the blood and look for bad things, pathogens. So, infections, even cancer cells, our T cells help get rid of all of those bad things that we’re not supposed to have. And they each have a receptor. And so, T cells have this night vision, and they’re made for a specific type of pathogen out there that we aren’t supposed to have that can hurt us.

And so, what we can is to either take your own T cells out, or sometimes with something called allo CAR-T use a normal donor’s T cells. And when we take them, we basically can put a new receptor in there, a new night vision; and so, now they are trained to go after something that’s specific on the myeloma instead of a bacteria or a virus or anything. And basically, we grow those cells, and then we give those cells back to our patient after a low dose of chemotherapy, just so these T cells can go in, find the myeloma, use that night vision to find that myeloma wherever it is, kill, and then it actually causes other immune cells in your system to come there and start helping to kill as well.

And then, they start coming back down again. And so, really, it’s a novel way of using your own immune system, or somebody else’s, but to actually enhance both by the target to get that myeloma precisely as well as making more of them so that there’s enough to go around and kill all the cells that we possibly can.

7 Things People with Cancer Need to Know About Infection

Everyone living with cancer understands the dangers of their disease. But did you know that infections cause, or are involved in, about 60% of all deaths for cancer patients? This is because many cancers, and many cancer therapies, can weaken your immune system. As you enter each phase of treatment, your doctors will prepare you for what to expect, but here are 7 things every patient with cancer — and those around them — need to know about infections. 

1. Know if you’re at risk, and when.

 Almost 20 million people are diagnosed with cancer each year, and nearly all cancer patients are likely to be immunocompromised at some point (or points) of their disease course. Hematologic cancers like leukemia, lymphoma, or multiple myeloma can weaken the immune system themselves, and certain solid cancers are related to diseases that weaken the immune system, like AIDS.

But even if your disease doesn’t impact your immune system, the treatment might. Most patients undergo treatments with chemotherapies, which attack the fast-dividing cells of the cancer, but also bone marrow that manufactures immune cells. Similarly, common treatments for blood cancers involve destroying and replacing bone marrow to reboot the immune system. Your doctor will inform you if you enter a treatment phase that requires extra caution and vigilance.

2. Understand the dangers of infections for the immunocompromised.

Patients with cancer may have unique challenges from infections that people with fully functioning immune systems may not. The most obvious issue is your body can’t mount its usual defense, leaving you unable to fight off what would be otherwise routine illnesses. Also, you are susceptible to certain types of pathogens, like certain fungal infections and hospital-acquired infections, that a healthy immune system would block early.

Importantly, your body’s common tools against infection — fever, inflammation, increases in certain easily-detected immune cells — are often the telltale signs of an infection. If they don’t occur normally, it’s easier to miss red flags of early disease, when treatment is often easier.

3. Protect yourself to avoid infection.

The best defense against infection is to not get one. Living through the pandemic has likely made you familiar with some common tools and strategies to minimize exposure to infectious diseases: wear the right mask, wash your hands frequently, and avoid contact with sick people and crowds. Vaccines can be important armor against infections, especially if you are not yet immunocompromised — but may become so later in treatment. (Your doctor can guide you on which vaccines to update.)

If you are already immunocompromised, it’s important for those around you with healthy immune systems to get vaccinated. They become your first line of defense.

If your white blood cell counts are low, you are considered neutropenic. Neutropenic patients should avoid hiking, where you risk exposure to molds growing in natural environment that might be dangerous. Similarly, avoid construction sites, which tend to aerosolize dirt — increasing the spread of dangerous pathogens.

4. Know the signs of infection.

Sometimes getting sick may be unavoidable. Infections may present differently in immunocompromised patients, depending on the type of infection, immune status, and how far a disease has progressed. But there are signs to watch for: 


This is the number one red flag, though it can be hard to interpret. When patients with low white blood cell counts have a fever it’s called febrile neutropenia. Because of the danger in developing a blood infection that escalates to life-threatening sepsis, patients will often be placed on broad-spectrum antibiotics immediately when presenting with a fever, though more accurate treatment. Fever, however, can also be a sign of cancer progression. 

Respiratory symptoms.

Things like shortness of breath or difficulty breathing can be signs of lung infection and pneumonia. 

Acute pain.

As with many symptoms, pain in the chest or abdomen are not necessarily signs of infection, but need to be investigated in immunocompromised patients 

Weight loss.

Weight loss is associated with serious infections like tuberculosis, which may be slow to show symptoms in patients with compromised immune systems. 


Another symptom that can have many causes.

5. Have a plan.

Don’t let the signs of infection catch you off-guard. The point at which you’ll be most at risk of infection is often predictable — for example, when white blood cell counts have dropped just after chemotherapy. This can help you prepare and stay vigilant.

Typically, doctors will advise blood cancer patients with signs of infection not to go to an emergency room — mixing with a general population of acutely ill patients could expose you to other dangerous pathogens. 

But that doesn’t mean to ignore symptoms or avoid care — if you wait until you experience drops in blood pressure or spiking fever, the outcomes could be worse. Instead, many oncologists recommend you call your cancer clinic, where your potential infection can be addressed by your doctors in a controlled setting. It’s understandable that patients will not want to be admitted too early, but early treatment tends to give better results. Make a plan with your specialists before you wind up in harm’s way. Speak with your family members so they know how to help you if you are in need. And know where you need to go.

6. Stay safe in the hospital.

The most common infections for immunocompromised patients are from opportunistic pathogens. This can include hospital-acquired infections, which is why most specialists will help you try to avoid the hospital if possible.

But sometimes it’s unavoidable. In these cases, you will most likely be transferred in from your cancer center or — after a phone call to your specialist — directly from home, avoiding the ER. Often, this means you will be in a dedicated cancer ward, intensive care, or otherwise segregated from people with normal immune systems. In any event, health care providers will be wearing masks and other protective gear to prevent exposing you to new pathogens. Hospitals also have additional safety protection like HEPA air filters and rigorous protocols to prevent contamination.

7. Be ready for the fight.

Clinicians will often use empiric antimicrobial therapy for cancer patients showing signs of infection. Under this approach, doctors begin the process of testing for the specific pathogen, but simultaneously start the patient on a broad-spectrum antimicrobial therapy while waiting for the results of testing. If testing can identify a specific cause, the doctors can switch to a more directed therapy that is appropriate for the specific illness.

If they can’t, there is still a chance the signs of infection will resolve, sometimes without ever finding a specific diagnosis. Those patients may have endured additional suffering, remained at elevated risk for new infections in a hospital setting, or encouraged antimicrobial resistance by treating a pathogen with an inappropriate treatment course. In the worst-case scenario, failure to identify the right pathogen may lead to worse outcomes for the patients.

The good news is that diagnostic testing is improving, and there are novel, highly accurate tools to help doctors get their patients on the most appropriate therapeutic course faster. This means directed treatment for more patients, earlier in the course of disease, for better outcomes with less antimicrobial resistance.