Daniella’s Stage 2 Primary Mediastinal B-Cell Lymphoma (PMBCL) Story

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Categories Cancers CAR T-Cell Therapy Chemotherapy Non-Hodgkin Lymphoma Patient Stories Primary Mediastinal B-Cell Lymphoma (PMBCL) R-EPOCH Radiation Therapy TreatmentsDaniella’s Stage 2 Primary Me

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Cancers CAR T-Cell Therapy Chemotherapy Non-Hodgkin Lymphoma Patient Stories Primary Mediastinal B-Cell Lymphoma (PMBCL) R-EPOCH Radiation Therapy Treatments

Daniella’s Stage 2 Primary Mediastinal B-Cell Lymphoma (PMBCL) Story

 

Daniella S., Primary Mediastinal B-Cell Lymphoma (PMBCL), Stage 2

 

 

Symptoms: Prolonged cough; low-grade fever; night sweats

Treatments: Chemotherapy (R-EPOCH), radiation, CAR T-cell therapy

 

Daniella’s Stage 2 Primary Mediastinal B-Cell Lymphoma (PMBCL) Story

Interviewed by: Alexis Moberger
Edited by: Katrina Villareal

Daniella recounts her journey through a stage 2 PMBCL diagnosis. She underwent chemotherapy and CAR T-cell therapy, and ultimately achieved remission. Initially attributing her symptoms to allergies, she experienced a persistent cough that worsened over time, accompanied by night sweats and low-grade fevers. Concerned by her symptoms, she sought medical attention and underwent various tests, leading to a diagnosis of primary mediastinal B-cell lymphoma (PMBCL).

Facing the shock of her diagnosis as a 28-year-old with no prior health issues, Daniella embarked on a treatment journey that included chemotherapy, fertility preservation, CAR T-cell therapy, and radiation. Throughout her treatment, she experienced side effects such as hair loss, fatigue, nausea, and fever, but she found strength in focusing on the present moment and relying on her support system, including family, friends, and medical professionals.

Despite setbacks and challenges, including a bout of COVID-19 and the discovery of residual disease after chemotherapy, Daniella remained resilient. She underwent CAR T-cell therapy, navigating delays and side effects, and ultimately achieved remission.

She acknowledges the ongoing emotional and psychological impact of her cancer journey, emphasizing the importance of taking things day by day, seeking support, and connecting with others facing similar experiences. As she continues to navigate survivorship, she encourages others facing cancer to lean on their support networks, seek professional assistance when needed, and remain resilient in the face of adversity.

In addition to Daniella’s narrative, The Patient Story offers a diverse collection of primary mediastinal B-cell lymphoma (PMBCL) stories. These empowering stories provide real-life experiences, valuable insights, and perspectives on symptoms, diagnosis, and treatment options for cancer.


  • Name: Daniella S.
  • Diagnosis:
    • Primary Mediastinal B-Cell Lymphoma (PMBCL)
  • Staging:
    • 2
  • Symptoms:
    • Prolonged cough
    • Low-grade fever
    • Night sweats
  • Treatments:
    • Chemotherapy (R-EPOCH)
    • Radiation
    • CAR T-cell therapy
 
Daniella S. timeline
Daniella S. timeline

This interview has been edited for clarity and length. This is not medical advice. Please consult with your healthcare provider to make informed treatment decisions.

The views and opinions expressed in this interview do not necessarily reflect those of The Patient Story.



Introduction

I grew up in the Tri-State area. I work for a large communications firm in New York City and live in Jersey City with my fiancé and dog.

Pre-diagnosis

Initial Symptoms

The journey started in the summer of 2022. It began with a tickle in my throat, which was very vague, and I attributed it to either allergies or the dry air in my apartment.

After a while, that tickle turned into a cough, which didn’t go away. After a few weeks of having that cough, I decided to go to urgent care. They thought I had bronchitis, which I thought was likely. I figured whatever I had probably turned into bronchitis. I was working a very high-paced job, was very career-oriented, and dismissed a lot of my initial symptoms.

Daniella S.

The doctor said it was the night sweats that concerned him the most. I don’t think that he thought of a potential cancer diagnosis because I was otherwise healthy.

Daniella S.
Symptoms Worsening

My symptoms got worse. When I went to urgent care, I was diagnosed with bronchitis and they treated me with steroids. My cough improved, which was great, but when I went off the steroids, my cough came back immediately. I went back to urgent care and they thought I had pneumonia.

The cough lasted four weeks before I thought it seemed like a long time to be going through it. I also started to develop a low-grade fever in the evenings. Even further along, I started to have night sweats, which I later learned was one of the symptoms of lymphoma.

The night sweats became apparent to me because they came with low-grade fevers. That’s when I thought I needed to see a doctor urgently because I knew that I was sick.

The doctor said it was the night sweats that concerned him the most. I don’t think that he thought of a potential cancer diagnosis because I was otherwise healthy. He was ticking off other things that it could be, but he called out the night sweats as concerning.

The night sweats got progressively uncomfortable to the point where I was waking up in the middle of the night to change my clothes. But I attributed that to some infection that had gone on for too long and now becoming severe. I didn’t even consider cancer.

My mom pushed me to ask for a chest X-ray from the urgent care doctor. The radiologist thought it was pneumonia, but the doctor scared me when I was told that it could be tuberculosis. I decided to get a second opinion.

Getting a Second Opinion

I sent the X-ray to my cousin, who’s a radiologist. She said the X-ray would be a lot worse if I had pneumonia. She pushed me to get a CT scan. I went to my primary care doctor and got a CT scan, which immediately revealed a large mass in the center of my chest.

Daniella S.

My cousin prepared us for the different possibilities, but it was still very much a shock.

Daniella S.

Diagnosis

This was something that we were anticipating at this point. My cousin prepared us for the different possibilities, but it was still very much a shock. I was an otherwise healthy 28-year-old with no prior history of anything and no history of lymphoma.

My primary care doctor asked me, “Do you work around any chemicals?” I said, “Unless you’re talking about the chemicals from the New York City subway, I don’t. I work in an office. I work on the computer.”

It was a huge shock when I was initially diagnosed. Upon receiving the results of the CT, we immediately went to the ER. From there, the process started in terms of finalizing my diagnosis.

Reaction to the Diagnosis

It was a crazy out-of-body experience for me. I would say I was somewhat primed for it. I was with my fiancé at the time, but I don’t know how primed he was for it. I remember seeing his face and the color draining from it. I immediately had an out-of-body experience and emotionally shut down in a way.

I knew that I needed to go to the ER so I didn’t have time to process what it all meant. The moment I received the news, I was shaking.

From that point on until the day I heard I was in remission, every moment of my life was lived minute by minute. I remember thinking to myself, I’m going to the ER. I’m going to the front desk. I’m telling them what’s going on. I’m sitting in my chair, waiting. They’re going to take me back to the ER.

I was living moment to moment, doing my best to not anticipate what was next. My life went from everything being planned to getting through by the minute, by the hour, or by the day. It was a big mindset shift for me.

In the initial moments of my diagnosis, I distinctly remember thinking that this couldn’t be happening to me. This is too insane. I was supposed to get married in seven months.

I thought that I couldn’t do this. I have an extreme fear of needles. How am I going to make it through knowing that they’re going to need blood work? I actively avoided needles for a long time and any blood work that wasn’t necessary. That’s how bad my phobia was so that was one of the main things that I discussed with everybody because that was tough for me.

Daniella S.

The interventional radiology team that did the biopsy was wonderful in keeping me calm throughout the process. They were so confident in what they were doing that it made me feel more relaxed and very well taken care of.

Daniella S.
Doing the Biopsy

I was admitted upon going to the ER. They had my CT results. From there, there were various consultations with doctors and potential surgeons to understand what we should be doing about the mass, considering that it was pushing on my chest and my heart, causing me to cough and some fluid to build up in my lungs. There was a lot of discussion on what we should be doing at this point.

They ultimately decided that they didn’t need to do anything urgently, but they scheduled a biopsy for me. They went back and forth to decide what type of biopsy to do. Ultimately, they went with a needle biopsy to get pieces of the tumor in my chest to be able to do the diagnosis and staging.

They wanted to do the biopsy before the weekend. I wanted to be knocked out during the whole process, but unfortunately, I had breakfast that morning before I knew that they were going to do the biopsy. To do the biopsy under anesthesia, I wasn’t supposed to eat, so they had to do the biopsy while I was awake. Luckily, they gave me lorazepam (Ativan) via IV so I was able to calm down before the biopsy.

Honestly, that experience went well and opened my eyes to a lot in terms of how this medical process works. The interventional radiology team that did the biopsy was wonderful in keeping me calm throughout the process. They were so confident in what they were doing that it made me feel more relaxed and very well taken care of. It was the first procedure that happened to me in my journey that made me feel like I could do it. That was the first moment of encouragement for me, knowing I could get through this.

Additional Testing

Following the biopsy, I had to have additional CT scans of my head, neck, and stomach. I also had to have a bone marrow biopsy to confirm the staging to see if the lymphoma was anywhere else.

The bone marrow biopsy was done under anesthesia. I was a little sore afterward and a little nauseous from the anesthesia, but otherwise, it was fine.

Getting the Official Diagnosis

After all of that testing, I got my final diagnosis a few days later. It was confirmed that I had stage 2 PMBCL or primary mediastinal B-cell lymphoma.

Daniella S.

I started the fertility preservation process while I was still in the hospital.

Daniella S.

Fertility Preservation

I was lucky to be able to do fertility preservation before starting chemotherapy, which I realized after my treatment was very rare. There were a lot of things that lined up that allowed me to do fertility preservation.

The fertility clinic is inside the hospital. When I was diagnosed, they kept me in the hospital for 10 days while they were doing all the procedures and monitoring. During that time, my doctor consulted with the fertility doctor at the clinic and she was able to come down to see me and talk to me about my options.

I started the fertility preservation process while I was still in the hospital. Had the clinic not been in the hospital building itself, they probably wouldn’t let me be discharged to undergo fertility preservation. When I decided to move forward, I was able to go to the clinic and do the tests that they needed. Otherwise, I don’t know if they would have let me so I was very fortunate in that sense.

Honestly, it took me a while to figure out that this was even going to be a part of the journey, but upon hearing what my options were, I was firm in my decision. That being said, I was also very scared because I knew it involved a lot more needles. Of course, that wasn’t fun, but I was no longer operating in what I wanted, but more so what I needed to do.

I went to the fertility clinic every day for blood work. They would monitor me and how my eggs were growing because they gave me hormones to stimulate my eggs so they could retrieve them.

I was doing hormone shots in the evening and going to the clinic so they could check on how my eggs were growing. After the clinic visit, I would go down to the cancer clinic where the doctor would check me. They were afraid that my cancer would grow since it’s a very aggressive lymphoma, that my symptoms would get bad again, and that I would need to start chemotherapy immediately.

I would go to the fertility clinic and then the cancer clinic every morning to see my doctor and get checked out. Then I would get myself an emotional support bagel and lay around all day and think about what was going on.

The fertility preservation process was not that bad. Besides some minor discomfort and minor bloating, it was very manageable.

Daniella S.

They were able to retrieve seven eggs. My fiancé and I decided to fertilize all seven eggs in the hope of creating healthy embryos.

Daniella S.
Egg Retrieval

Upon my egg retrieval, my doctor warned me that my body was fighting something so there was a chance that they might not be able to get any eggs. I went in understanding that it might not turn out how we wanted, but they were able to retrieve seven eggs. The procedure was done under anesthesia, which was something I was very familiar with at the time. The egg retrieval process itself was fine.

I had the egg retrieval done in the morning. I was out of there probably by noon or 1 o’clock. After they did the retrieval, they brought me to the recovery area. When I woke up from anesthesia, they wanted me to walk around a little bit before sending me home. That evening, I was admitted to the hospital for my first round of chemotherapy.

Embryo Freezing

They were able to retrieve seven eggs. My fiancé and I decided to fertilize all seven eggs in the hope of creating healthy embryos because that’s what my doctor recommended. If I were to freeze seven unfertilized eggs, they might not survive the thawing process. Embryos are a little more robust. They’re a little tougher so my doctor recommended trying to fertilize all seven eggs.

We had to wait a few days to find out how many of those eggs were fertilized and how many of those fertilized eggs turned into big enough embryos for us to freeze. We ended up being able to freeze five embryos, which is pretty good when you consider that we fertilized only seven eggs to get five good-quality embryos. That was a success.

Truthfully, I was so happy with how the experience went. Knowing that I had five embryos in storage was a big motivator for me and gave me a lot of hope that even beyond surviving cancer, I would still be able to have a family. I was thankful to be able to have that possibility.

Daniella S.

If your fertility doctor can talk to your oncologist and make a plan, there can be workarounds that would allow you to do it.

Daniella S.

Everybody’s scenario is different, but if it’s important to you, definitely explore every resource and avenue that you can to do it. It’s not easy, but it’s not too difficult if you want it and if it’s really important to you.

I’m a huge proponent of doing everything you can, advocating for yourself, and asking how you can get fertility preservation done. If your fertility doctor can talk to your oncologist and make a plan, there can be workarounds that would allow you to do it.

I had to be on blood thinners during the whole process. I gave myself blood thinner shots every morning while going through fertility preservation. My doctor was afraid that I would develop blood clots, especially considering the hormones. There were risks, but there are also ways to mitigate those risks and work around them. Advocate for fertility preservation, if it’s important to you.

Treatment

Discussing the Treatment Plan

Everything was moving pretty fast. I celebrated my birthday in the hospital. I was diagnosed on September 29th and turned 29 on October 1st, which was a very surreal experience to celebrate my birthday in the hospital during this time.

My doctor was very communicative about my treatment options, even though we were still confirming what type of lymphoma I had and what the staging was. He went through the options of either doing R-EPOCH chemotherapy or R-CHOP chemotherapy, both of which are similar to each other.

R-EPOCH is what he was leaning towards. He explained that R-EPOCH was going to be done inpatient at the hospital for five days. I would get chemo for five days, wait for three weeks, go back for the next round, and do that cycle for six rounds. R-CHOP would be outpatient.

After receiving my diagnosis, he said that I was going to do six rounds of R-EPOCH chemotherapy, which equated to about six months of treatment. I would be in the hospital receiving chemotherapy, come in to see him a few days later, and then two weeks after that, be back in the hospital for my next round of chemo.

Daniella S.

The anticipation of side effects was worse than any side effects that I felt. I had a lot of anxiety about what I would feel and what I would be going through.

Daniella S.
Side Effects of Chemotherapy

My oncologist explained what I could expect from the chemo, the first one being hair loss. He noted that I would be fatigued and that I could be nauseous. He was very good. He wrote down everything for me. He also drew pictures of where the lymphoma was. It was very helpful in those moments for him to write everything down for me.

He explained to me that I should expect to feel pretty crappy the week after chemotherapy and have a good week during that second-week break before I would be in for my next round.

The anticipation of side effects was worse than any side effects that I felt. I had a lot of anxiety about what I would feel and what I would be going through, but none of my worst nightmares came true except one.

The side effects were quite manageable. The hair loss was something I knew was a given upon diagnosis, so I tried my best to not focus on it. I didn’t want to give the thought of losing my hair power. What I was most concerned about was losing my eyebrows, which was tough.

After the first round of chemotherapy, I started to lose my hair, which was traumatic — I don’t think there’s any way that it can’t be. I cut my hair short before starting chemotherapy with the hope that it wouldn’t be as apparent when it did fall out, but it fell out in clumps in the shower. It was constant. I woke up with hair on my pillow. It was very hard to go through that process.

Once I was able to shave my head, it felt so much better because then I wasn’t constantly dealing with hair falling out in clumps. I bought a lot of head wraps and wore a lot of beanies. I was going through treatment during the winter time mainly, so I was able to do that. I tried to not give it so much power and kept telling myself that it would come back.

Daniella S.

The side effects compounded as I got more and more chemo. As I went through the rounds, the side effects got a little tougher.

I struggled with fatigue and some nausea. The nausea wasn’t overwhelming and I was able to take ondansetron (Zofran) to handle it, but it was mainly overwhelming fatigue and an overall feeling of malaise. I would explain to my friends that it was like a bad hangover, a feeling of not having any energy and can’t get out of bed.

I stayed with my parents because they lived close to the hospital. There were days when I only stayed on one floor because I was afraid that if I went down the stairs, I wouldn’t have the strength to come back up or I would lose my balance.

There was always a general feeling of unwellness between cycles. My body would rebound in the last week and I would start to feel a little bit better and have a little bit more energy.

The side effects compounded as I got more and more chemo. As I went through the rounds, the side effects got a little tougher. Overall, I considered myself pretty lucky in the way that my body was able to handle all of the chemotherapy.

I had to deal with one bout of COVID during my second cycle of chemo, which was awful. My symptoms weren’t awful, but getting COVID set off a bunch of logistical headaches with my chemotherapy that were tough to deal with and manage. I had to advocate hard for myself. That was a tough roadblock, but we got through it.

Post-Treatment Scans

I finished treatment in February 2023. We were feeling very confident about how things were and how the treatment went. I had a good midway scan. They saw that the mass in my chest was shrinking a lot. Everything was moving back into place, as my doctor said. Things were clearing up so it was a good sign that the chemotherapy was working, which was great.

CT scan

When I received the news that there was still residual disease, that was truly crushing not only for me but for my family and my fiancé who were on their own journeys considering my cancer diagnosis.

Primary Mediastinal B-cell Lymphoma PMBCL
This image was originally published in ASH Image Bank. Timothy C Carll, MD; Girish Venkataraman, MD, MBBS. Primary Mediastinal B-cell Lymphoma. ASH Image Bank. 2018; 00061366. © the American Society of Hematology.
Residual Disease

I had to wait a month after I finished my last day of chemotherapy to have my last PET scan where two spots lit up. That was tough because we weren’t expecting it. There’s a 50% chance there could be inflammation and a 50% chance that it could be residual disease.

We had to do another biopsy, which was a little bit more invasive. They put me under for that one because they needed to get samples to see if it was residual disease, which it was.

Truthfully, those weeks were the toughest. After my diagnosis, I was able to tell myself that it was just six months of my life. I was going to be able to get through this and then everything’s going to go back to normal. I was going to get my life back. That’s what got me through the six rounds of intense chemotherapy, saying that it was only six months and that I could do this.

Since I had residual disease, I was going to be on this ride for a lot longer and I didn’t know what to expect. My doctors were very encouraging. Considering that I was so young, didn’t have a prior history, could handle the chemotherapy, and that it would probably work, I had a good chance of being cured.

We were holding on to that hope, but when I received the news that there was still residual disease, that was truly crushing not only for me but for my family and my fiancé who were on their own journeys considering my cancer diagnosis. It was heartbreaking news for all of us. There were definitely a lot of tears.

My team very quickly referred me to a larger cancer hospital and connected me with the CAR T team there. They had already gotten the ball rolling for me to do CAR T-cell therapy.

Daniella S.

There were a lot of questions about whether or not I needed CAR T-cell therapy or additional radiation to clear up the small spots that were left over. There was a lot of back and forth.

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CAR T-cell Therapy

I knew about CAR T-cell therapy because I read stories on The Patient Story about other patients who had lymphoma and have gone through CAR T-cell therapy. I understood the basics and what patients can expect to go through. My family had a lot of learning to do. But again, I was still living moment to moment, day by day. What were the next steps? Who do I need to talk to about CAR T-cell therapy?

While I knew about it, it was still very scary to me. Mentally, I was at a point where I didn’t want more treatment, but, at the same time, I knew that I had to steel myself for additional treatment.

Once I met with my CAR T-cell therapy team, I felt lik

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