Lymphoma is a cancer that arises in the cells of the immune system. It exists in many different forms, which can have very different courses. One of these variants is mycosis fungoides, a rare form of cutaneous lymphoma. For most patients, it remains relatively inactive for a long time, but around a quarter of patients eventually experience more aggressive progression, requiring rapid treatment.
In order to provide the right treatment to the right patient, there is a need for a better understanding of the biological factors that influence the course of the disease.
On 5 June, Angelica Johansson defended her doctoral thesis, entitled Biological and Psychosocial Axes of Lymphoma Outcome – From Tumour Microenvironmental Profiling to Patient-Reported Determinants. Angelica was a PhD student at the Department of Immunotechnology and the Agenda 2030 Graduate School at Lund University. In her thesis, she investigated the biological mechanisms influencing lymphoma progression. She also adopted an unusual research approach, investigating patients’ quality of life and their own experiences of illness.
By studying patients with mycosis fungoides, Angelica Johansson identified biological changes that may explain why the disease progresses to a more advanced stage in certain individuals. In studies of diffuse large B-cell lymphoma, the most common form of aggressive lymphoma, she observed that the composition of immune cells in and around the tumour was clearly linked to survival.
Her research also yielded an unexpected result: patients with mycosis fungoides reported high psychological resilience and a good quality of life despite living with chronic cancer.
What have you studied?
'I have studied the role of the immune system and quality of life in patients with lymphoma, with a focus on mycosis fungoides, a skin lymphoma, and diffuse large B-cell lymphoma (DLBCL), the most common form of aggressive lymphoma.'
Why did you choose to study this – why is it important?
'Lymphomas are highly heterogeneous diseases, meaning patients can have very different outcomes and treatment responses. We aim to determine whether the immune compartment can be used to stratify lymphoma patients to improve survival and to identify biomarkers that can guide more personalized treatment strategies. This is especially important as new immunotherapies become available.'
What are the key findings?
- 'We found that patients with mycosis fungoides had high psychological resilience and a good quality of life despite living with a chronic disease that can cause lifelong symptoms.
- We also identified biological changes that may explain why some patients develop a more advanced form of the disease.
- In patients with DLBCL (an aggressive lymphoma), we observed a clear link between the composition of immune cells in and around the tumour and survival. This suggests that analysing the tumour’s immunological environment could help identify patients who could benefit from different types of immunotherapy.'
Was there anything that surprised you?
'One interesting finding was that patients with mycosis fungoides reported relatively high levels of psychological resilience and quality of life despite living with a chronic and potentially progressive cancer.
It was also interesting to see how strongly the tumour’s immunological environment was linked to survival in patients with DLBCL, highlighting the importance of factors beyond the tumor cells themselves.'
What do you hope could come out of this research?
'I hope this research will contribute to more precise and individualised treatment strategies for lymphoma patients in the long-term. I also hope that integrating biological and patient-reported data will lead to more holistic patient care.'
Read more about Angelica Johansson
A link to Angelica's thesis will be added soon (some manuscripts in the thesis are not published yet)