Hodgkin's Disease Treatments: Finding a Lymphoma Cure

"Hodgkin's disease is very curable."

These are the confident words of Dr. Nancy Mendenhall, of the Department of Radiation Oncology, University of Florida, Gainesville. She explains that "until about 1950, [HD] was thought of as universally fatal. It was known to be sensitive to radiation, but the disease always seemed to come back."

But then came the breakthrough.

Dr. Mendenhall continues: "Several investigators noted that the patterns of recurrence were predictable and began treating not only the involved area with radiation, but adjacent areas as well. With this addition, patients began to be cured of Hodgkin's disease."

Dr. Alan C. Aisenberg of the Department of Hematology and Oncology at Massachusetts General Hospital, Boston, also believes that Hodgkin's lymphoma "is highly curable . . . which is interesting because we really don't understand Hodgkin's disease as well as the other lymphomas . . . but we cure it best."

Treatment Strategies for Hodgkin's Lymphoma

Treatments vary according to the type, stage and grade of the tumor, as well as the age and general health of the patient.

Chemotherapy and/or radiation therapy can successfully treat most cases of Hodgkin's disease. In addition, excellent results are currently being achieved with new antibody therapies for patients who have already been treated with radiation or chemotherapy.

Bone Marrow Transplants

In some instances, a bone marrow or peripheral blood stem cell transplant may be necessary. Transplants are needed particularly when a patient has received very high doses of chemotherapy or radiation that destroys normal bone marrow. In these cases, a transplant of bone marrow or stem cells is used to restore healthy bone marrow.

Current treatment strategies and new lymphoma treatments may include one or a combination of the following:

radiation therapy—either localized or including adjoining regions of the body
chemotherapy—using a single high dose drug or a combination of drugs
combination therapies—chemotherapy in combination with radiotherapy
steroids, in combination with other therapies
a bone marrow or stem cell transplant in combination with high dose chemotherapy or radiotherapy
surgery, in combination with other therapies
antibody-based therapies.

Hodgkin's Lymphoma Cure Rates

Using present treatment strategies, current cure rates for Hodgkin's disease are more than 80 percent (Shaffer et al., 2002). Furthermore, with recent advances in finding a new cure for HD, the situation is improving all the time. In the case of nodular sclerosis type lymphoma, for example, cure rates are as high as 95 percent.

The likelihood of completely eradicating the cancer depends largely on the stage of the tumor. Stage I cure rates are as high as 95 percent; even Stage IV rates are around 60 to 70 percent. Patients over the age of forty, however, have a worse prognosis.

In general, some Stage I and II localized tumors, particularly Stage IA disease that has nodular sclerosis or a lymphocyte predominant histology, can be successfully treated with radiotherapy alone. However, patients with early Stage I and II who also present symptoms of fever and weight loss have a higher relapse rate. These patients should receive a combination of chemotherapy and radiotherapy.

Patients with more advanced forms of the disease generally require chemotherapy in addition to radiation. In the most advanced stage, Stage IV, radiation is ineffective and most patients receive a cocktail of several different medications.

Clinical Trials: The Way Forward

Findings from recent high-profile clinical trials assessing new cures for Hodgkin's disease are highly encouraging. Today, individuals who participate in one of the many studies to find a Hodgkin's lymphoma cure stand to benefit from the most advanced forms of treatment available to those suffering from the disease.

Rituximab: Several clinical trials are currently examining the efficacy of monoclonal antibody-based treatments for Hodgkin's disease.

The proteins on the surface of cells are called antigens. A monoclonal antibody is simply a protein that is made to "recognize" a specific marker antigen that, in this case, is found on the surface of the Reed-Sternberg cells associated with Hodgkin's disease.

One of the most effective and extensively tested manufactured antibodies is the unmodified antibody MabThera™ anti-CD20 drug Rituximab. Referred to in clinical trials as "CD20," this particular antigen is present on the surface of some subsets of "B" cell lymphomas.

The antibody recognizes the RS cell antigen and attaches to the cell, targeting that cell for destruction by the immune system. In clinical trials, monoclonal antibodies such as Rituximab have been shown to be particularly effective at locating HD tumor cells without harming normal cells.

Radionuclide Therapy: Other clinical trials are testing alternative forms of antibody treatments, including those that target the cancerous cells and are linked to toxins or radionuclides that eradicate the tumor.

Radionuclide therapy involves the selective delivery of therapeutic radionuclides to diseased cells using targeted carriers, with little damage to normal tissues.

Although radionuclides have been used for over fifty years for treating thyroid disorders, they have been used only recently to treat Hodgkin's disease. Renewed interest in the capabilities of radionuclide therapy is largely due to the many recent advances in bioengineering and the production of monoclonal antibodies for treating HD.

Resources

American Cancer Society (updated 2005). What is Hodgkin's disease?

Beers, M. H., & Berkow, R. (ed). Hodgkin's disease. The Merck Manual of Diagnosis and Therapy, 17th Edition. Merck Research Laboratories, NJ, 1999.

ClinicalTrials.gov (updated 2005). Rituximab in treating patients with Hodgkin's lymphoma.

Coiffier, B. (2003, March). Monoclonal antibodies combined to chemotherapy for the treatment of patients with lymphoma. Blood Reviews, 17, 25-31.

Fauci, A., Braunwald, E., Isselbacher, K., Wilson, J., Martin, J., Kasper, D., Hauser, S., & Longo, D. (ed). Harrison's Principles of Internal Medicine, 14th Edition. McGraw-Hill, NY, 1998.

Lymphoma Information Network (2000). Childhood Hodgkin's disease.

Lymphoma Research Foundation (2002). Learn about lymphoma.

National Cancer Institute (updated 2002). What you need to know about Hodgkin's disease.

North Western Medical Physics (2002). Radionuclide therapy: Still evolving after all these years.

Oncology Channel (updated 2005). Hodgkin's disease.