Young newlywed, UTSW cancer team wage 'Infinity War' on stage 4 lymphoma
May 14, 2025
Lymphoma is one of the most sinister villains in the cancer universe. There are dozens of subtypes, each with its own nuances and insidious characteristics.
Originating in the lymphatic system – the network of tissues and fluids that help the body fight infection – lymphoma isn’t just a blood cancer. It's a whole-body cancer that spreads rapidly wherever blood flows and hides in the tiniest alleyways of the body’s immune system.
Taking down such a stealthy nemesis requires an expert team and a patient who won’t stop in the pursuit of a cure, no matter the obstacles.
Erik Torres of Roanoke, Texas, is that guy.
When I met Erik, he had already seen several oncologists and undergone multiple treatments. A year prior, an emergency department visit for a stubborn cough had revealed that Erik’s chest and abdomen were completely full of cancer. At age 22, he was diagnosed with stage 4 lymphoma – the most advanced form of the disease.
Erik’s initial doctors recommended tried-and-true treatments for aggressive lymphoma: multiple rounds of chemotherapy and CAR T-cell therapy, an advanced treatment to enhance his immune system.
Nothing worked. Each cycle left his body tattered, giving the cancer more foothold to grow.
A lot of people with stage 4 lymphoma do not survive even with aggressive treatment, especially if the cancer comes back after the first treatment. But Erik was young, fit, and otherwise healthy. If anyone could take down this villainous illness, it would be him.
But we had to get creative. His body wasn’t responding to traditional treatments. That’s where the multidisciplinary team at UT Southwestern Harold C. Simmons Comprehensive Cancer Center becomes invaluable. New technologies and therapies continue to be developed. And we have the expertise to sift through those options that didn’t exist just a few years ago and put together a viable plan.
So, with his wife, Lexi, and the care team by his side – and the help of a novel antibody/chemotherapy medication that cleared the way for a stem cell transplant – Erik prepared for the final showdown that would put his cancer into remission.
Lymphoma: The origin story
In September 2022, several weeks after recovering from COVID-19, Erik couldn’t shake a chest-rattling cough that seemed to be getting worse. Lexi, who was his girlfriend at the time, drove Erik to a local emergency department to see if he’d caught pneumonia.
As they waited for Erik's chest imaging results, the college sweethearts chatted about what kind of takeout they’d get on the way home – they'd moved in together just a few weeks earlier. But when the provider came back into the room, they immediately knew something was wrong.
“They asked if it was OK for Lexi to be in the room and see the results,” Erik said. “Then they showed us a picture of the huge mass in my chest.”
A subsequent biopsy came back positive for cancer. After a week’s stay in the hospital, Erik was referred to a Dallas oncologist. A PET scan showed that the mass was much more insidious than anyone realized. Tumors crowded the space between his breastbone and spine, extending down to fill his entire abdomen. Cancerous cells surrounded his heart, and his liver had been infiltrated with tumors.
The Dallas oncologist officially diagnosed Erik with stage 4 non-Hodgkin lymphoma in October 2022 and referred him to a specialist in Fort Worth to start treatment right away.
What is lymphoma?
Lymphoma is an umbrella term for more than 80 unique cancers that form in lymphocytes (white cells). These lymphocytes can reside in the 600-plus lymph nodes, the liver, and the spleen that make up the immune system. Lymphoma tumor cells are found in these tissues and also in the bloodstream and the bone marrow, where healthy blood cells are formed.
Lymphoma can cause vague symptoms such as swollen lymph nodes, fever, weight loss, and persistent coughing or chest pain. By the time it’s apparent that something is wrong, the disease is typically advanced, and the treatment options are limited. About 33% of people with non-Hodgkin lymphoma already have stage 4 disease at the time of diagnosis.
Round 1: Chemotherapy
“The first oncologist was confident that Erik would need six rounds of chemotherapy, and that would be it,” Lexi said. “That gave us hope.”
Traditional chemotherapy can’t tell the “good guys” (healthy blood platelets, red cells, and white cells) from the “bad guys” (cancer cells). Like Thanos wiping out heroes alongside villains in “Avengers: Infinity War,” traditional chemo indiscriminately clears good and bad cells. The goal is for healthy cells to eventually return, but sometimes the bad guys repopulate faster.
Erik’s cancer cells were running amok, adapting and dividing. His tumors didn’t respond after five chemotherapy treatments, and he needed frequent blood transfusions just to keep his body functioning. In April 2023, the oncologist referred Erik to another hospital in Dallas for CAR T-cell therapy.
“We all thought the CAR T-cell therapy would beat the cancer,” Erik said. “We were optimistic when we went back to Dallas.”
Round 2: CAR T-cell therapy
CAR T-cell therapy is a type of immunotherapy medication. It enhances a patient’s immune system to eliminate cancer cells. For lymphoma, the treatment is a four-step process:
- A sample of T-cells is extracted from a patient’s blood. The job of T-cells is to destroy abnormal or infected cells, but sometimes cancer makes this impossible without help.
- The sample T-cells are genetically modified in a lab to produce special molecules called chimeric antigen receptors (CARs) on their surface that can destroy cancer cells.
- The patient gets a short cycle of chemotherapy to deplete immune cells that might attack the modified T-cells.
- The modified T-cells are returned to the patient through an IV, with the expectation that they will seek and eliminate cancer cells.
For CAR T-cell therapy to work, patients need to have enough “good guys” left in their blood to accept the rally cry and help drive out the cancer. Erik’s blood platelets count had plummeted to zero. Though some spots shrank at first, the cancer rebounded with vigor. In August 2023, a PET scan showed a new cancer growth on his spleen.
Erik and Lexi decided to seek second opinions from oncologists in Houston and Atlanta, where they hoped Erik could enroll in a clinical trial. But after multiple rounds of aggressive treatment, he was fatigued, he’d lost too much weight, and even with regular blood transfusions, his blood counts were too low to qualify for most clinical trials.
“When you're going through something like this, if you tell yourself every day, ‘Oh, I'm not going to make it,’ you're not going to make it. You have to stay positive. Remind yourself, ‘I got this. I'm going to get through it,’” says Erik, who credits Lexi’s love and support for helping him through. “We just prayed about it.”
The couple’s bond grew stronger. They got engaged during one of their trips to Atlanta in November 2023.
“It wasn’t how either of us had planned our engagement to go,” Lexi said, “but we did what we’ve always done – made the best of a tough situation together.”
Tough is an understatement.
With Erik’s condition rapidly declining, neither second opinion resulted in a new approach. In November 2023, the Houston oncologist referred Erik to UT Southwestern to wage a final showdown with the cancer.
Comprehensive care
The UT Southwestern Harold C. Simmons Comprehensive Cancer Center is the only National Cancer Institute-designated comprehensive cancer center in North Texas and one of only 57 such centers across the U.S. Its treatment of leukemia, lymphoma, and myeloma is rated as "High Performing" by U.S. News & World Report, placing UTSW among the nation’s top hospitals for this area of care.
Round 3: Down, but not out
After all that had happened, Erik and Lexi were still optimistic, but they were not interested in sugarcoating. I cut to the chase: None of the tried-and-true treatments had worked. The one thing that could save Erik was a stem cell transplant – a procedure to replace his decimated immune system with a healthy one.
Erik was too sick to attempt the transplant right away, so the first goal was to try to shrink the tumors and increase the “good guys” on his team. UTSW was participating in a clinical trial for a drug called epcoritamab. This bispecific T-cell engager antibody medication attracts T-cells to cancer cells, with the hope of eliminating them.
Despite our success treating several other patients with bispecific antibody medications, this drug did not work for Erik. He saw positive results for a few months, but the “bad guys” came back with a vengeance. Still, he and Lexi were undeterred.
“When the first attempt with Dr. Awan didn’t work as expected, we didn't feel discouraged,” Lexi said. “It felt normal to just try the next thing when something didn’t take. To be honest, it would have been weird if it had worked right away!”
Their optimism held, Lexi and Erik married in a private ceremony at home in March 2024. Soon after, Erik would begin the treatment that would lead to his lymphoma’s downfall.
Round 4: Pola-RICE lands the knock-out punch
In spring 2024, Erik started on an antibody-only therapy of polatuzumab vedotin with rituximab (Pola-R). This is a combination of synthetic monoclonal antibodies – proteins that are trained to locate cancer cells by homing in on specific antennae-like antigens on the outside of harmful cells. The antibodies activate the patient’s immune system to eliminate cancer cells.
Pola-R took off like a lightning bolt, zapping Erik’s chest-sized tumors with more vigor than any of us expected. After two cycles, his masses began to shrink, and his blood counts began to rise. We suspect this is because the cancer had spread into his bone marrow, which is the spongy area inside the bone where blood particles form. So, with this new treatment, the antibodies were stopping the “bad guys” at ground zero – and giving Erik a break from blood transfusions for the first time in months.
This progress gave us confidence to kick things up a notch. On the third treatment cycle, we added a novel five-drug chemotherapy cocktail, collectively called Pola-RICE. After that initial dose, Erik's coughing subsided for the first time in two years. His imaging showed that the cancer had shrunk dramatically. After the third round of Pola-RICE, his follow-up imaging was squeaky clean – not a spot of cancer in sight.
Countdown to the stem cell transplant
“After the Pola-RICE, Dr. Awan came in the room and said, ‘You're playing games with me,’” Erik chuckled as he recalled the conversation. “Then he said, ‘It worked – there are no detectable cancer cells in your body. You are ready to get the stem cell transplant.’”
Donated stem cells need about two to three months to enter the bloodstream and generate new, healthy immune cells. If there are a lot of stealthy cancer cells lurking in the body or the lymph nodes, the donor cells may not be able to fight the cancer and the transplant may not be successful in eliminating the cancer cells. Using highly sensitive technology that can detect one cancer cell in a million normal cells, the team was able to establish that there was no evidence of circulating cancer cells.
The last step before Erik could get a stem cell transplant was to get a new radiation therapy conditioning protocol called total marrow lymphoid irradiation (TMLI). He started the treatment in May 2024.
TMLI is an alternative to whole-body radiation therapy. We can modulate the radiation beams to specific intensities for certain areas of the body, protecting healthy tissues while eliminating "bad guys” that are hiding throughout the body. This precise treatment, combined with chemotherapy, helped suppress Erik’s immune system so we could “sneak in” the donor stem cells and reduce the risk of rejection.
Delivering TMLI requires a team of experts in Stem Cell Transplantation, Radiation Oncology, and nuclear medicine as well as specialized technologies to map the patient’s body and cancer sites. UTSW is one of just a handful of centers in the U.S. with the expert team and technology to offer this treatment.
The final showdown: Stem cell transplant
Finding a stem cell donor with DNA similar to Erik’s would improve the chances that his body would accept the transplant. Neither of his brothers was a close enough match, so Erik was listed on the donor registry.
The first donor who matched decided not to go through with the procedure. Thankfully, a second donor matched just a few weeks later.
Stem cell donation is no longer a laborious, painful procedure. In most cases, the donor cells are extracted in a simple, four-hour IV procedure that is comparable to getting dialysis or donating plasma. Receiving a stem cell transplant is a similar process. On July 19, 2024, we infused a solution of healthy stem cells, plasma, and saline into Erik’s bloodstream and set him up in a recovery room.
His final obstacle would be the roughest to date. Erik developed graft-versus-host disease (GVHD), a complication that can occur after any type of transplant. The donated stem cells were waging civil war on Erik’s healthy tissues, misinterpreting their new environment as a threat.
“Mild 'Hulking out’ of the immune system is expected following an allogeneic transplant,” said Julio Alvarenga Thiebaud, M.D., a UTSW expert in hematology and oncology as well as GVHD management. “It can be a sign the donor cells are doing their job and helping eliminate the blood cancer or immune disease that necessitated the transplant.”
However, unmanaged or severe GVHD can be life-threatening. Erik stayed in our hospital for a month and a half with Lexi by his side every night and day. He took immune suppressants and got treatment to manage GVHD-associated nausea, diarrhea, and musculoskeletal pain.
Erik’s strength slowly returned, and in August 2024, his nemesis was defeated. He and Lexi could finally go home.
Homecoming ... alone
The first 100 days after a transplant are delicate. Doing simple daily activities that healthy people take for granted, such as going to the grocery store, significantly increases the risk of infection for someone with a new immune system.
“If Erik had caught a bad cold or the flu, it could have killed him,” Lexi said. “So we couldn’t be around anyone.”
Lexi had grown accustomed to the constant stimulation and socialization in the hospital. But at home, Erik was too sick and fatigued to hold a conversation for most of September and October 2024. With no visitors and no outings except for doctor’s appointments, Lexi began to feel very alone.
“I was in a dark place for a while, struggling with anxiety while still trying to take care of him,” Lexi recalled. “It was hard seeing photos of our friends going on dates and taking trips when every day we were isolated, and I was constantly worried that I was going to lose my one true love.”
Lexi sought mental health support from her primary care provider, and she began to heal alongside Erik as he regained his strength and energy. By December 2024, they were starting to feel like themselves again and attended their first family get-together as a married couple.
Finally, in remission
To our mutual joy, Erik’s cancer remains in remission.
Seeing Erik and Lexi now, you wouldn’t believe the challenges they've faced. The newlyweds bought a house in Roanoke, and they’re planning a honeymoon. Erik works for a patio maintenance company and runs a car detailing business, and Lexi is a dog groomer.
But all of us at UT Southwestern know this is just their disguise. Behind their civilian personas, Erik and Lexi are superheroes.
“I can’t express how amazing the UT Southwestern team is,” Erik said, "from the amazing Dr. Awan and Dr. Alvarenga to the nurses, social workers, and housekeepers at the hospital and everyone in between. Without UTSW and my wife, I would not be alive today.”
Lexi agreed, saying, “We always had each other to lean on, and now I feel like there’s nothing we can’t overcome together.”
To talk with an expert about lymphoma treatment, make an appointment by calling 214-645-8300 or request an appointment online.
