Consultant in the Division of Hematology and Professor of Medicine at the Mayo Clinic College of Medicine
Please briefly describe Hodgkin lymphoma.
Hodgkin lymphoma is a lymphoproliferative disorder, which is an abnormal proliferation or growth of B lymphocytes. Malignant B lymphocytes in classical Hodgkin lymphoma are called Reed-Sternberg cells, and are actually in the minority, compared with a vast majority of other immune cells that were activated in response to the malignant cells. The results of that response are enlarged lymph nodes, most commonly in the neck, chest, abdomen, and groin, and then spreading outside of the lymph nodes, into other organs as well.
How common is Hodgkin lymphoma?
Hodgkin lymphoma is a relatively uncommon disease. It affects about 9,000 new patients within the United States every year, probably about ten percent to eleven percent of all lymphoma cases in the country. It is far less common than non-Hodgkin lymphoma, but is still a significant issue for those who are ill from this disease.
How is Hodgkin lymphoma typically treated?
Treatment is specifically managed depending on factors such as how much of the patient’s body is affected, exactly where the disease is, and whether there are any features to suggest a good or poor prognosis.
The most commonly used and standard therapy is a four-drug combination called ABVD (adriamycin, bleomycin, vinblastine sulfate, dacarbazine). Patients with limited-stage disease (confined to one side of the diaphragm) usually receive two–four cycles of ABVD chemotherapy then involved-field radiation; patients with more extensive disease (present on both sides of the diaphragm, or outside of the lymphatic system) commonly receive six cycles of ABVD chemotherapy.
What are the areas of research for Hodgkin lymphoma?
There are two broad categories for research in Hodgkin lymphoma. The first focuses on better understanding the biology of the disease. For example, there are studies investigating how the Reed-Sternberg cells recruit immune cells and interact with the immune system in general. The goal is to use this information to develop new therapies for patients.
The second large category of research is aimed at optimizing and improving therapies. The goal is to try to understand how much therapy patients need, minimizing therapy for those with a good outcome and optimizing therapy for those with a less positive outcome. Another facet of research is developing novel approaches to treatment by using new drugs in development as part of front-line therapy.
Do you talk to patients about enrolling in a clinical trial?
Yes, we try to have clinical trials available for most patients, whether they have limited-stage, extensive-stage, or relapsed disease. When patients participate in clinical trials, it allows us to give them the best therapy that we think should be used. It also allows us to move the research field forward, as we understand the disease and the therapies better.
What is on the horizon for Hodgkin lymphoma research and treatment?
This is an exciting time in Hodgkin lymphoma treatment because a number of the more recently developed drugs are really making a significant impact. Patients who have failed various treatments have shown a very high and durable response rate when treated with brentuximab vedotin (Adcetris), which is now going to be evaluated in front-line therapy regimens.
Although this has been a disease with a relatively good prognosis, the hope is that the outcomes become even better, and more patients have a durable long-term outcome and are cured with therapy.
How are you involved with the Lymphoma Research Foundation and why would you recommend the patient become involved with the Lymphoma Research Foundation?
I am involved with the Lymphoma Research Foundation in two ways. Firstly, I serve on their Scientific Advisory Board, and, secondly, I am a recipient of funding from the Lymphoma Research Foundation for research in non-Hodgkin lymphoma.
The Lymphoma Research Foundation is an invaluable resource for patients because they provide information, education, and opportunities for connecting and networking with others who have a similar diagnosis.