Overview

Patients with relapsed Hodgkin’s lymphoma are curable and can be further divided into two broad categories. Patients who fail to achieve an initial complete disappearance or remission of their cancer following a complete course of chemotherapy treatment are referred to as “induction failures.” Other patients achieve a complete remission to initial treatment and later experience a cancer recurrence. These patients are said to have relapsed Hodgkin’s lymphoma. Relapse of cancer may occur several months to years after the initial remission; however, the majority of relapses occur within 2 years of initial treatment.

A variety of factors ultimately influence a patient’s decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient’s chance of cure, or prolong a patient’s survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatments for relapsed Hodgkin’s lymphoma. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Treatment of Induction Failures

Patients who fail to achieve an initial complete remission or disappearance of their cancer following a complete course of chemotherapy treatment are referred to as “induction failures.” This is a broad group since it includes patients whose cancer actually grew or progressed during chemotherapy as well as those with an almost complete disappearance of cancer. Historically, all of these patients were treated with additional chemotherapy using drugs to which the patient had not been previously exposed and/or radiation therapy. Treatment of induction failures with several cycles of “salvage” chemotherapy produces a complete remission of cancer in 30%-40% of patients and 0-20% of patients survive without an additional cancer relapse.

In the 1980′s, many clinical centers around the world began routinely utilizing high-dose chemotherapy with autologous stem cell transplantation as initial treatment of induction failures. High-dose chemotherapy and autologous stem cell transplantation appeared to cure 40-50% of patients, which was a marked improvement over traditional conventional chemotherapies, which cured only 10-25% of patients.

To confirm the benefit of high-dose chemotherapy as initial salvage treatment for induction failures, investigators in London performed a clinical trial that evaluated high-dose chemotherapy and autologous stem cell transplantation compared to conventional chemotherapy. The results of this clinical trial were published in 1993 in the journal Lancet and demonstrated that high-dose chemotherapy and autologous stem cell transplantation improved the duration of survival and cure of patients compared to conventional chemotherapy. Patients treated with high-dose chemotherapy had a 53% chance of being alive without disease recurrence, compared to only 10% for patients treated with conventional chemotherapy. High-dose chemotherapy has become the standard initial salvage treatment for the majority of patients with Hodgkin’s lymphoma failing to achieve an initial remission. In order to learn more, select Stem Cell Transplantation.

Treatment of Relapsed Hodgkin’s Lymphoma

Historically, patients that relapse with Hodgkin’s lymphoma were treated with additional chemotherapy using drugs to which the patient had not been previously exposed and or radiation therapy. Treatment of relapsed patients with several cycles of “salvage” chemotherapy produces a complete disappearance or remission of cancer in 30%-40% of patients and as many as 25% survive without an additional cancer relapse.

In the 1980′s, many clinical centers around the world began routinely utilizing high-dose chemotherapy with autologous stem cell transplantation as treatment for patients with relapsed Hodgkin’s lymphoma. High-dose chemotherapy and autologous stem cell transplantation appeared to cure 40-50% of patients, which was a marked improvement over traditional conventional chemotherapies, which cured only 10-25% of patients.

To confirm the benefit of high-dose chemotherapy as salvage treatment for patients with relapsed Hodgkin’s lymphoma, investigators in London reported the results of a clinical trial that evaluated high-dose chemotherapy and autologous stem cell transplantation compared to conventional chemotherapy. The results of this clinical trial were published in 1993 in the journal Lancet and demonstrated that high-dose chemotherapy and autologous stem cell transplantation improved the duration of survival and cure of patients with Hodgkin’s lymphoma. Patients treated with high-dose chemotherapy had a 53% chance of being alive without disease recurrence, compared to only 10% for patients treated with conventional chemotherapy. High-dose chemotherapy has become the standard salvage treatment for the majority of patients with relapsed Hodgkin’s lymphoma. Some patients with relapsed Hodgkin’s disease may benefit from an allogeneic stem cell transplant. These patients include those with refractory disease or large cancers or who have insufficient stem cells available for an autologous stem cell transplant. In order to learn more, select stem cell transplantation.

Strategies to Improve Treatment

The progress that has been made in the treatment of relapsed Hodgkin’s lymphoma has resulted from the development of high-dose chemotherapy regimens, new treatment strategies and their evaluation in clinical trials. Future progress will result from continued participation in appropriate clinical trials. Currently, there are several areas of active exploration aimed at improving the treatment of Hodgkin’s lymphoma.

New Chemotherapy Regimens: Development of new multi-drug chemotherapy treatment regimens that incorporate new or additional anti-cancer therapies for use as treatment is an active area of clinical research carried out in phase II clinical trials in patients with relapsed or recurrent lymphoma.

Stem Cell Transplant: New techniques and technologies designed to increase the effectiveness and decrease the side effects of stem cell transplant are being evaluated. To learn more, select Stem Cell Transplant.

Phase I Trials of Chemotherapy: New chemotherapy drugs continue to be developed and evaluated in phase I clinical trials. The purpose of phase I trials is to evaluate new drugs in order to determine the best way of administering the drug and to determine whether the drug has any anti-cancer activity in patients with lymphoma. Phase I trials are usually performed in patients with recurrent or refractory cancer.

Gene Therapy: Currently, there are no gene therapies approved for the treatment of lymphoma. Gene therapy is defined as the transfer of new genetic material into a cell for therapeutic benefit. This can be accomplished by replacing or inactivating a dysfunction gene or replacing or adding a functional gene into a cell to make it function normally. Gene therapy has been directed towards the control of rapid growth of cancer cells, control of cancer death or efforts to make the immune system kill cancer cells. A few gene therapy studies are being carried out in patients with refractory lymphoma. If successful, these therapies could be applied to patients with earlier stage disease.

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