Halina’s Story about Primary Central Nervous System (CNS) Lymphoma
Around New Year's Eve, Halina Frydman’s husband noticed changes in his wife's personality. Soon after, she was diagnosed with primary central nervous system lymphoma, which arises in lymphocytes, a type of white blood cell. She came to Memorial Sloan Kettering to receive treatment through a clinical trial.
Can a husband dance too much with his wife on New Year’s Eve?
Roman Frydman’s motives for dancing the night away with his wife, Halina — while loving — were not entirely to ensure that she would have a good time at a New Year’s party welcoming 2005. Instead, he was concerned about recent, disturbing personality changes he had observed in her — including uncharacteristic anger toward a friend attending that night’s celebration.
“My husband danced with me a lot that evening because he didn’t want me to interact with too many people,” says Dr. Frydman. “He recognized there was something wrong.”
Several days later, in her office at New York University’s Stern School of Business, where she is a professor of statistics, Dr. Frydman realized she was unable to focus on her work. Returning to her apartment, she tried to read a book. Her husband, also a professor at NYU, asked what she was reading.
“I couldn’t tell him,” Dr. Frydman recalls. “That’s when he got very upset and called a friend, a psychiatrist, who said, ‘Take Halina to the emergency room now.’”
At NYU Medical Center, an MRI scan of Dr. Frydman’s brain showed a tumor. Immediately admitted to the hospital, she began a course of steroids. The tumor shrank dramatically.
She explains: “At first, the doctors suspected it was a metastasis from the breast cancer I had in 1999. But because it shrank so much and so fast, they thought, ‘This is not a solid tumor.’”
A brain biopsy followed and finally a diagnosis: primary central nervous system (CNS) lymphoma. Dr. Frydman had been treated for breast cancer at Memorial Sloan Kettering by medical oncologist Clifford A. Hudis (now Chief of the Breast Cancer Medicine Service) and wished to be treated at the Center again.
Dr. Hudis referred the Frydmans to neuro-oncologist Lisa M. DeAngelis, Chair of the Department of Neurology (and now Physician-in-Chief and Chief Medical Officer at MSK).
“CNS lymphoma is a rare cancer that can involve the brain, spinal cord, eyes, or the coverings of the brain and optic nerve, called the meninges,” says Dr. DeAngelis. “The designation of the disease as a lymphoma reflects the fact that the cells from which this cancer arises are lymphocytes, a type of white blood cell.”
Dr. DeAngelis enrolled Dr. Frydman in a clinical trial consisting of methotrexate — a chemotherapy drug that was given in very high doses — along with the chemotherapy drugs vincristine and procarbazine, and a monoclonal antibody called rituximab.
“CNS lymphoma of the type that Dr. Frydman had used to be treated with whole-brain radiation, which can damage normal brain structures and affect cognitive function,” explains Dr. DeAngelis. “At Memorial Sloan Kettering, we’ve pioneered the use of chemotherapy for these tumors. Although radiation continues to play a role, we are exploring significantly reducing the doses. In patients who have received chemotherapy and low-dose radiation we don’t see cognitive damage and the majority of them are doing extraordinarily well.”
The protocol for the trial still called for whole-brain radiation, albeit at a reduced dose. However, following chemotherapy, a scan of her brain showed no signs of cancer and Dr. Frydman decided against it.
“I was worried that I wouldn’t have been able to go back to my work,” says Dr. Frydman. “I asked Dr. DeAngelis, ‘In your opinion, if I don’t do the radiation, will I put myself at a higher risk of a recurrence?’ She said no. She was very open-minded about it.”
“Dr. Frydman had gone into complete remission and had made a full clinical recovery,” says Dr. DeAngelis, “so I felt I could support her decision.”
Dr. DeAngelis concludes, “What we have learned — and lymphoma is one of the best examples of this — is that underlying brain tissue is not necessarily destroyed by tumors; therefore effective treatment really can restore people to functionality.”
Halina Frydman has certainly been restored. She has returned to a full life of teaching, researching, writing, and publishing. And today, she and her husband dance just for the fun of it.