Making Plans Nine Years After Non-Hodgkin Lymphoma

Marlene Marovich and Sonali Smith, MD
Marlene Markovich, left, meets with lymphoma expert Sonali Smith, MD.

Marlene Markovich asked God to help her survive cancer so she could have a few more years with family, especially her five young grandchildren. "I prayed for one more baseball game, one more school activity, one more birthday," she said. "Now I attend games and graduations and I think, ‘Thank you God for letting me be here.' I have such a good time being involved with my grandchildren."

In February 2003, just after getting a diagnosis of non-Hodgkin lymphoma, 60-year-old Markovich sat in an exam room at the University of Chicago Medicine feeling anxious and scared. "Once I met Dr. Sonali Smith, I knew I would be taken care of," she recalled. "She gave me so much hope. It felt like she took me in her arms, gave me a big hug and held on. When I think about it, I can still just cry."

A nursing services director for St. Margaret Mercy Healthcare Center in northwest Indiana, Markovich had been experiencing pain, fatigue and weight loss for months. She dismissed these and other symptoms, telling herself, "If I only could take a year off, maybe I'd feel better." The pain persisted and while working the night shift one evening, she tried to talk to a fellow nurse and didn't have the air to speak. She walked down to the emergency room.

A chest x-ray showed an accumulation of fluid around her lungs. Further tests revealed enlarged lymph nodes in her chest and abdomen, as well as an enlarged spleen. A lymph node biopsy confirmed a suspicion of non-Hodgkin lymphoma.

"Once I met Dr. Sonali Smith, I knew I would be taken care of," Markovich said.

Lymphoma refers to a family of cancers usually originating in a lymph node, but which may also begin in other parts of the lymphatic system (the organs, tissue and vessels in the immune system that fight disease and infection). Markovich was diagnosed with diffuse large B-cell non-Hodgkin lymphoma, an aggressive form of the disease characterized by a malignancy of B-cells, lymphocytes that are normally involved in the production of antibodies. For Markovich, the disease already had spread extensively.

"When I finally read up on my cancer, I realized I could have had "lymphoma" written right across me," she said. "I guess I made excuses for all of my symptoms."

Sonali Smith, MD, and Marlene Markovich In April 2013, to mark the 10-year anniversary of her non-Hodgkin lymphoma diagnosis, Markovich surprised Smith with a dozen red roses.

She told her primary care physician that she wanted to find the best of the best for her treatment, saying, "At my age, I am only going to get one good chance." Her doctor recommended Smith, a hematologist/oncologist at the University of Chicago Medicine and a nationally recognized expert in adult lymphoma. In Markovich's 40 years of nursing, she worked with many doctors who had transferred patients to the medical center for specialty care. She knew there was a high regard for the institution.

Clinical Trial Offers Aggressive Approach

Smith's team of specialists performed a work-up that included a CT scan and a bone marrow biopsy. These tools were used not only to stage the disease but also to give the medical team a baseline evaluation from which to measure Markovich's progress during treatment. In addition, University of Chicago Medicine hematopathologists (pathologists who specialize in diagnosing blood and lymph node disorders) identified the precise type of non-Hodgkin lymphoma. "With more than 60 subtypes of non-Hodgkin lymphoma, it is essential for us to pinpoint the exact type," Smith said. "Our hematopathologists are among the best in the country at classifying lymphomas."

Her age and the extent of her disease, which was stage IIIB, put Markovich at risk for a poor outcome. Smith offered her two options for treatment: the conventional chemotherapy for non-Hodgkin lymphoma or participation in a National Cancer Institute clinical trial being tested at the University of Chicago Medicine and 11 other centers in the country. While several of the medications used in the clinical trial were the same as those in the conventional therapy, the trial offered a more aggressive approach that involved inpatient stays with continuous infusions of chemotherapy.

"Because the patient is hospitalized for infusions, we can personalize the therapy, tailoring each dose to the patient's needs at the time," Smith explained. "I explained to Ms. Markovich that the standard course was good, but perhaps not good enough for her situation. The clinical trial let us push the envelope."

Opting for the trial, Markovich believed in her treatment even when dealing with difficult side effects. "As hard as it was sometimes," she said, "I did not get discouraged. I was the one who wanted the best care; I told myself, just do it." She showed promising results after the fourth round of treatment and by July 2003, her cancer was in complete remission.

More Life to Live

After a year of medical leave, Markovich went back to her job and worked for four more years before retiring in 2008. Now, she and her husband, Jerry, occasionally travel and spend time doing everyday things together, like working in the yard, shopping and going out to lunch. Her girlfriends, many who are also nurses, are retiring and Markovich says they have lots of plans. "We are going to start a book club, organize a card night and get day trips going," she said. "I have a lot to look forward to." Of course that also includes more baseball games, more school activities and more birthdays with her grandchildren.

Clinical Trial Update: When Ms. Markovich took part in the R-EPOCH (an acronym for the medications used) clinical trial in 2003, the study was classified as Phase II. This phase of testing investigated the safety of the medications and evaluated the effectiveness of the treatment regimen. R-EPOCH is now in Phase III trials where it is being compared to the conventional treatment and is open to a larger number of participants. Contact our lymphoma team for more information or browse our lymphoma trials:
» Hodgkin lymphoma clinical trials
» Non-Hodgkin lymphoma clinical trials

Original Story: May 2012, Updated April 2013