Innovations in the Treatment of Hodgkin Lymphoma
Hodgkin Lymphoma is one of the most successful types of cancer to treat today. This disease usually manifests itself with enlarged lymph nodes. Sweating, weakness, weight loss, or fever that is not due to infection may be symptoms of the disease. Depending on which part of the body the lymph nodes are in, symptoms such as shortness of breath and cough may also occur. The goal in the treatment of the disease is to completely eradicate the disease, if possible, and to prevent the recurrence of the disease. There are some groups in the world that work to make improvements in the treatment of Hodgkin Lymphoma and carry out large-scale studies, a few of them are the German Hodgkin Lymphoma Study Group (GHSG), EORTC, Canadian NCI. To date, 15,000 Hodgkin patients have participated in the work of the German Hodgkin Lymphoma Study Group (GHSG). If the disease has not spread to the body, the disease can be eliminated with treatments that include mild chemotherapy and irradiation. If the disease has advanced and has spread further throughout the body, more effective chemotherapy treatments have also been developed to increase the chance of eradicating the disease. The following article is for general informational purposes. It is recommended that the disease be treated by a doctor experienced in Hodgkin lymphoma.
Symptoms of the disease
Hodgkin Lymphoma usually presents with enlargement of the lymph nodes or spleen. Lymph nodes in the neck are most commonly involved, but lymph nodes in the inner parts of the body may also enlarge. Apart from this, the spleen, liver or other organs may also be involved. Some patients experience the following symptoms: Weight loss (10% in the last six months), night sweats, recurrent fever that is not due to an infection. These symptoms are called “B symptoms”.
Diagnosis of the disease
For the diagnosis of the disease, a suitable lymph node should be taken and examined. Hodgkin lymphoma includes various subgroups in pathological examination, the treatment of these groups may vary.
In addition to this examination, studies showing how far the disease has spread throughout the body are also carried out, which we call “staging”. The stages (stages) of the disease are:
Stage I: Involvement of a single lymph node region
Stage II: 2 or more lymph nodes on one side of the diaphragm (the muscle separating the chest and abdominal cavity) Involvement of the node region
Stage III: Involvement on both sides of the diaphragm
Stage IV: Widespread involvement of an organ other than the spleen (the spleen is considered a lymph node region in this disease).
Computed tomography is required to determine the stage of the disease, some blood tests and tests showing how organs such as the heart and lungs are working are required to plan the treatment.
In addition to staging, some findings also define poor risk factors for the disease. Findings that we call risk factors negatively affect the rate of recovery of the disease depending on the situation, but they should be evaluated together with other data. In order to save patients with bad risk factors, it may be necessary to apply a more effective treatment according to the stage.
According to the German Hodgkin Lymphoma Study Group (GHSG), these risk factors are:
-Involvement of three or more lymph node areas
-High sedimentation
-Large mediastinal mass (wider than 1/3 of the rib cage)
-Extranodal (outside lymph nodes) involvement.
Treatment of the disease
According to pathological findings, the disease is divided into classic type Hodgkin lymphoma and a less common subgroup (lymphocyte predominant). This rare subgroup shows characteristics. The following introduction applies to the classic type of Hodgkin lymphoma.
It is important to start the treatment of the disease without unnecessary waste of time and to apply the treatment regularly. In terms of treatment, the disease can be divided into three groups:
Group 1: Early stage, no bad risk factors
Group 2: Early stage, but with some risk factors
3. Group: Advanced disease.
Studies in recent years have targeted stages in two subjects in particular. The first of these includes patients with early stage and no bad risk factors. Since the treatment results in these patients are already very good, the studies have aimed to maintain the good results but to reduce the side effects of the treatment. The second issue is to increase the rate of success in treatment and eradication of the disease in Hodgkin lymphoma patients with more advanced disease.
Early stage, patients without bad risk factors
For both stage I or II patients and patients without any of the above mentioned bad risk factors, a very short course of 2 cycles of chemotherapy and a low dose radiation therapy constitutes a good treatment option. This study by the German Hodgkin Study Group in 1370 patients showed that patients treated with only 2 cycles of chemotherapy and radiation therapy had significantly fewer side effects. The study, published in the New England Journal, found that 91% of patients who received two cycles of chemotherapy and radiation therapy were still successful after 5 years of treatment. When the 20 to 30 Gray dose of radiation therapy was compared, there was no difference in effect.
Early stage, but patients with some risk factors
This group includes Hodgkin lymphoma patients outside the above and below groups. In these cases, usually 4 cycles of ABVD chemotherapy and 30 Gray radiation therapy are considered standard treatment. For patients under the age of sixty in this group, the German Hodgkin Study Group conducted a study in 1522 patients. Since this study showed that 5 years of progression-free (without progression in the disease) survival after 5 years increases by 6 percent, if 2 courses of “escalated BEACOPP” protocol + 2 courses of ABVD and radiation therapy are applied instead of a chemotherapy protocol called 4 cycles of ABVD and radiation therapy. treatment is also a good option.
Advanced disease group
This group includes patients with stage III or IV, plus patients with stage IIB with either a large mediastinal mass or extranodal (except lymph node) involvement. In patients with this condition, it is more difficult to achieve complete eradication of the disease compared to the other group of patients. These patients can be given 6-8 cycles of ABVD chemotherapy on an outpatient basis. Another option is a chemotherapy protocol called “escalated BEACOPP”. As a result of the studies carried out by the German Hodgkin Study Group, it was published that the possibility of controlling the disease with the chemotherapy protocol called “escalated BEACOPP” is better than standard chemotherapy in this group and in patients younger than sixty years of age. In the first course of the “escalated BEACOPP” protocol, which is applied as 6 cycles, the patient needs to be hospitalized. The “Escalated BEACOPP” protocol is a more intensive protocol that requires good patient follow-up and experience. After the treatment in these patients, according to the results of PET-CT (the device that provides the simultaneous acquisition of Positron Emission Tomography and Computed Tomography images), some patients do not need radiation therapy.
Resistant or relapsing disease
In this situation, if the patient is younger than 65 years of age, a treatment that usually includes a stem cell transplant (bone marrow transplant) is recommended. Stem cells are collected from the patient, this type of stem cell transplantation is called autologous transplantation.
There are some drug options for patients who cannot undergo stem cell transplantation. The antibody called Brentuximab vedotin is also among the new treatment possibilities.
Follow-up: After the treatment is completed, it is of great importance to follow up the patient and the disease at certain intervals.
