CRMC's State-of-the-Art Cancer Center Offers Treatment for a Rare Lymphoma

Six years ago, Bobby Sebastian of Cookeville, an avid cyclist for years, started having a very difficult time completing the usual trips with his cycling group.


At first, he chalked it up to getting out of shape from taking a couple of months off to remodel his home. But when he was still having extreme fatigue two months later, along with drenching night sweats and itchy skin, his biking friends — several of whom are doctors — encouraged him to see his doctor.


His family doctor drew some blood, and when he got the results, he sent Sebastian to a hematologist at CRMC. They found that his hemoglobin count was only six, and he was hospitalized for anemia.

“It took four units of blood just to get my hemoglobin back up to 10, and for a man, normal is somewhere between 13 to 18,” said Sebastian.


He was placed in the care of Dr. Venumadhav Kotla, an oncologist at the Cookeville Regional Cancer Center.


“I was hoping I’d picked up some kind of blood parasite or something on one of these mission trips,” said Sebastian, who is the missions pastor at Life Church. “But they did a bone biopsy on me, and the results showed that I have a rare, stage 4 non-Hodgkin lymphoma called Waldenstrom macroglobulinemia (WM).”


WM grows in the bone marrow and crowds out the normal cells that make blood cells. Symptoms of WM can include anemia, fatigue, weakness, blurred vision, loss of vision, headaches, loss of appetite, fever, sweats, weight loss and possibly numbness or “pins and needles” sensations in the feet and legs.


“WM is a slow-growing lymphoma that is not very aggressive,” said Dr. Kotla. “The defining feature of Waldenstrom is production of IgM protein, an immunoglobulin that is not a functioning protein. It makes the blood viscous (thick), which is what causes the symptoms patients experience.”


Sebastian was placed on an immunotherapy medication called Rituxan®, which was able to control his disease for three years before he relapsed.


“Because his relapse happened closer to the use of our first choice of treatment, we could not use the same treatment, so we switched to a medication called ibrutinib (brand name Imbruvica®), which is a very new, targeted therapy option that was approved by the FDA in 2017,” said Dr. Kotla.


Sebastian has continued to do well on Imbruvica for three years now. Fortunately, even if he were to develop side effects or become unresponsive to this treatment, there are several other options available for his continued care.


“From a patient perspective, this is a disease that has evolved from where it was very difficult to manage because there were no standard treatments available a decade ago, and now we’re able to bring the progress of science to the clinic,” said Dr. Kotla. “This disease truly never goes away, but you can get very effective control.”


Now six years past his diagnosis with WM, Sebastian is continuing to enjoy life.


“I’m doing fine. I feel good. I rode my bicycle 20 miles this morning up the mountain, so life is good,” said Sebastian.


And, for him, managing his WM is simply a matter of continuing on his medication and having his blood checked regularly.


“I’ll probably have to have my blood drawn every six weeks for the rest of my life, but hey, I’ll take that,” said Sebastian. “Dr. Kotla is wonderful, and the nurses — I’m spoiled. At the Cancer Center, I walk in, two minutes later they come get me, 10 minutes later I’m walking out of the building with a printout in my hand. The Cancer Center here is wonderful.”