Talking lymphoma with Associate Professor Jake Shortt
Non-Hodgkin lymphoma (NHL) is a large group of related diseases that encompasses more than 70 different subtypes and exciting progress is being made in this field every day.
“They’re all cancers of the immune system,” said Associate Professor Jake Shortt, consultant haematologist at Monash Health/University.
He also is Head of Haematology Research and Principal Investigator on a range of clinical trials. Talking Lymphoma was the subject of his presentation at the Leukaemia Foundation’s Blood Cancer Conference (Melbourne, October 2018).
These diseases, which arise from a part of the immune system called the lymphocytes, are classified as either B-cell or T-cell, and further classified as indolent (slow growing) or aggressive (fast growing).
Assoc. Prof. Shortt said it was important for people to know exactly what kind of NHL they had, as these diseases all have different prognoses and treatments.
“There’s a lot of hope and a lot of effort to try and find better treatments, and we’re finding them all the time,” he said.
“The field is moving so quickly and it’s so exciting.”
In the treatment of NHL, an important development was the addition of rituximab to standard chemotherapy a decade ago.
The next paradigm shifts are immunotherapy, where the power of the immune system is unlocked to improve cure rates, and the advent of CAR T-cell therapy where a person’s T-cells are genetically engineered to kill their lymphoma.
And Assoc. Prof. Shortt thinks the next big breakthrough is the integration of new treatments (immunotherapies, small molecules, epigenetic drugs) and precision medicine, also known as personalised medicine. This involves finding out what gene mutations a person has, and based on that information, the best drugs are used to treat that person’s lymphoma.
“Precision medicine will be the way of the future,” said Assoc. Prof Shortt.
Assoc. Prof. Shortt encourages his patients to learn about their disease from credible, high quality sources such as the Leukaemia Foundation.
“It’s a tough battle and everyone has their own journey,” he said, but he emphasised the benefits of knowing about the challenges they may face, the importance of the treatments that may make them feel unwell before they get better, and of having a positive approach.
He also said it was important to choose a clinician who works in a peer-reviewed environment to care for you.
Even though lymphoma is “the thing” that really interests him, he can’t hope to keep up with all the information on the latest lymphoma treatments.
“In our own clinics, the biggest diagnostic and treatment decisions are made at a multidisciplinary meeting,” he said, as it was a good way to ensure there were a few brains in the room working on the same problem.
The two most common questions patients ask Assoc. Prof. Shortt are: ‘why did I get lymphoma and what causes it?’.
“There’s no easy answer,” he said. “It’s not like smoking and lung cancer, or UV light and melanoma. For want of a better explanation, it’s largely bad luck.”
The other question is ‘what food should I eat and should I take vitamins or supplements?’.
He said no food or lifestyle change was “particularly relevant” but emphasised “staying fit and healthy” and during chemotherapy, avoid eating leftovers – a potential cause food poisoning.