{"id":65845,"date":"2022-09-22T13:57:24","date_gmt":"2022-09-22T19:57:24","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=65845"},"modified":"2023-06-23T09:15:35","modified_gmt":"2023-06-23T15:15:35","slug":"combine-lymphoma-and-crohns-disease-takes-a-village","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/combine-lymphoma-and-crohns-disease-takes-a-village\/","title":{"rendered":"Combine lymphoma and Crohn\u2019s disease and it takes a village"},"content":{"rendered":"
<\/div>
\"Emily
Emily Solomon\u2019s combination of lymphoma and Crohn\u2019s disease took a team to treat.\u00a0Photos by Cyrus McCrimmon for UCHealth.<\/figcaption><\/figure>\n

Emily Solomon, a busy working mother of four, wasn\u2019t terribly concerned when she noted a lump near her groin in late 2018. The 48-year-old Denver resident had had surgery for an inguinal hernia<\/a> two decades before, and the lump was in that neighborhood. Still, she figured it wise to bring it up with Dr. Ann Klein<\/a>, her physician with the Women’s Integrated Services in Health (WISH<\/a>) clinic at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a>. Klein\u2019s clinical evaluation led the doctor to agree with her patient. But just to be sure, Klein suggested, she would order an ultrasound.<\/p>\n

\"Dr.
Dr. Ann Klein<\/figcaption><\/figure>\n

Those results didn\u2019t indicate a hernia, and a subsequent biopsy found something else entirely. The lump was malignant: Solomon had a type of non-Hodgkins lymphoma.<\/p>\n

They had caught it early, and the prognosis was good. There was, however, a complication: Solomon had been diagnosed with Crohn\u2019s disease<\/a> back in 2009, and while the inflammatory bowel disease was in check, it would complicate both her cancer care and the management of her Crohn\u2019s disease. The crux: You treat Crohn\u2019s disease by suppressing the immune system to cool off inflammation; you treat non-Hodgkin\u2019s lymphoma, among other ways, by bringing the immune system into the cancer fight.<\/p>\n

Starting on rituximab infusions<\/strong><\/h2>\n

Dr. Manali Kamdar<\/a>, clinical director of lymphoma services with the University of Colorado School of Medicine\u2019s Division of Hematology, took the lead in Solomon\u2019s cancer treatment. This was a slow-growing marginal-zone lymphoma<\/a> that Kamdar felt would respond to rituximab, an immune-system-stoking monoclonal antibody which she described as \u201cthe backbone of how we have managed lymphomas for a very long time.\u201d Solomon would start on rituximab infusions at the University of Colorado Cancer Center<\/a> at University of Colorado Hospital.<\/p>\n

Despite all this, Solomon felt, as she put it, \u201cfit as a fiddle.\u201d<\/p>\n

\u201cMy husband and I would joke that I\u2019ve got lymphoma and Crohn\u2019s and I look and feel fine,\u201d she said. \u201cLike, you open the hood, and this is what you find.\u201d<\/p>\n

As she stepped into the University of Colorado Hospital elevator with husband Jay en route to her first infusion February 2019, Solomon took note of the huge photos of patient success stories and said to herself, \u201cI want that to be me.\u201d<\/p>\n

That would be her, but it wouldn\u2019t come easy.<\/p>\n

A dose of rescue therapy<\/strong><\/h2>\n
\"Dr.
Dr. Manali Kamdar<\/figcaption><\/figure>\n

Just over a year into her series of rituximab infusions, she fell ill with her first-ever Crohn\u2019s flare. Solomon found herself bereft of energy, bedridden, and largely unable to eat. This went on for a solid three months. Her husband Jay, daughters Maddie and Bella, and sons Noah and Aiden brought her meals and kept the household ship afloat during the coronavirus pandemic lockdown. Like so many others during that time, she put off seeking medical care for weeks, until she spiked a fever in late May and felt she had no choice. Emergency Department physicians at University of Colorado Hospital admitted her.<\/p>\n

Dr. Blair Fennimore<\/a>, a CU School of Medicine gastroenterologist with the UCHealth Digestive Health Center – Anschutz Medical Campus<\/a>, took charge of her Crohn\u2019s disease care. This was \u201ca serious flare-up,\u201d as he described it, and one with potentially serious consequences. If 72 hours of high-dose intravenous steroids or a dose of rescue therapy with an anti-inflammatory biologic didn\u2019t quell her immune system\u2019s attack, a colectomy<\/a> was a real possibility.<\/p>\n

\u201cIf the patient doesn\u2019t respond to rescue therapy, you can go to colectomy in a week\u2019s time,\u201d Fennimore said.<\/p>\n

Despite the steroids, blood tests showed Solomon\u2019s inflammatory markers to have scarcely budged. She needed a dose of rescue therapy and a miraculous turn around, or she would face surgery. Then there was her lymphoma.<\/p>\n

A balance between inflammatory bowel disease medications and cancer care<\/strong><\/h2>\n
\"Emily
Emily Solomon with her family. Photo courtesy of Kara Pearson Photography.<\/figcaption><\/figure>\n

Adalimumab (Humira), which Solomon had been taking for years with success, very slightly increases lymphoma risk. Whether or not Solomon had been one of those rare cases (less than a handful per 10,000 people taking the drug, Fennimore says) in which Humira can lead to cancer didn\u2019t matter now. What did matter was that her lymphoma wouldn\u2019t somehow take advantage of whatever Fennimore would prescribe to tame Solomon\u2019s dangerous Crohn\u2019s inflammation. That left only a couple of inflammatory bowel disease medications on the table. Fennimore conferred with Kandar, and he also presented Solomon\u2019s case at a weekly multidisciplinary conference among Anschutz Medical Campus IBD experts including gastroenterologists, pharmacists, dietitians, a GI psychologist and colorectal surgeons.<\/p>\n

\"During
During the pandemic, this was as close as Emily Solomon could get to her family during her nine-day hospital stay. Photo courtesy of Emily Solomon.<\/figcaption><\/figure>\n

With their input, Fennimore settled on an anti-inflammatory biologic<\/a> called ustekinumab<\/a> (trade name Stelara) \u2013 an atypical choice for rescue therapy, but one that balanced the competing needs of her Crohn\u2019s and lymphoma. For more than a week, her husband and kids drove from their Denver home to a hospital parking lot. There they stood far below Solomon\u2019s eighth-floor window and FaceTimed with her as she observed them from on high. This was as close as she could get with the pandemic\u2019s pause on hospital visitors.<\/p>\n

\"Dr.
Dr. Blair Fennimore<\/figcaption><\/figure>\n

As the ustekinumab quelled her inflammation, she gained strength and felt better, but not before she had missed Aiden\u2019s fifth-grade continuation and Bella\u2019s high school graduation. On her ninth day, she was healthy enough that, with Fennimore\u2019s blessing, she was discharged so she could be home for son Noah\u2019s high school graduation \u2013 as with so many others that year, a socially distanced affair involving a procession of vehicles.<\/p>\n

Solomon stayed on the combination of ustekinumab and rituximab. Her Crohn\u2019s disease and her lymphoma have stayed at bay, and by August 2022, she had the honor of ringing the \u201call-clear\u201d bell at the Colorado Cancer Center. She knows, though, that both Crohn\u2019s and lymphoma are chronic conditions, and while there\u2019s a chance that she can taper from these drugs and remain Crohn\u2019s- and cancer-free, the odds are greater that she\u2019ll stay on them and, with medical advances, other therapies to keep it that way.<\/p>\n

Communication is key when dealing with dual diseases<\/strong><\/h2>\n

Kamdar considers Solomon\u2019s successful outcomes to have emerged from the fruitful communication among not only medical experts from several disciplines, but with Solomon herself, who took detailed notes throughout her care, asked questions, and stayed engaged.<\/p>\n

\u201cEmily is at the fore of all of this,\u201d Kamdar said. \u201cThe quality of life that she has is thanks to her and the seamless communication that was possible among these different specialties that could give her the best care.\u201d<\/p>\n

Solomon attributes her health to the care at University of Colorado Hospital.<\/p>\n

\"Emily
Emily Solomon rings the cancer-free bell surrounded by her family after battling lymphoma while having Crohn’s disease. Photo courtesy of Emily Solomon.<\/figcaption><\/figure>\n

\u201cI cannot say enough about the ways in which I benefitted from the UCH system \u2013 from the specialty providers and their level of expertise, the research focus that is integral to UCH, and the ways in which all my providers have continually communicated and worked together on my behalf,\u201d she said.<\/p>\n

Fennimore, who has seen IBD patients respond well and less well to various therapies, is simply happy for Solomon.<\/p>\n

\u201cShe\u2019s got her life back, you know? It\u2019s amazing for her,\u201d he said.<\/p>\n","protected":false},"excerpt":{"rendered":"

Emily Solomon, a busy working mother of four, wasn\u2019t terribly concerned when she noted a lump near her groin in late 2018. The 48-year-old Denver resident had had surgery for an inguinal hernia two decades before, and the lump was in that neighborhood. Still, she figured it wise to bring it up with Dr. Ann […]<\/p>\n","protected":false},"author":23,"featured_media":65853,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[6],"tags":[28,223,743,181,9187],"class_list":["post-65845","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthy-living","tag-cancer-care-oncology","tag-cancer-care-and-hematology","tag-digestive-health-liver-and-pancreas-gastroenterology","tag-gastroenterology","tag-readysetco"],"acf":[],"yoast_head":"\nLymphoma and Crohn\u2019s disease: It takes a village - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Emily Solomon\u2019s combination of lymphoma and Crohn\u2019s disease took a team to treat. 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